Samuel Ustayev, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1858649 Issued in MA

Practice address

367 Harvard St
Brookline, MA 02446-2938

Phone

(617) 277-1112

NPI assigned

Oct 2, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coolidge Corner Dental

  • General Practice Dentistry
  • Brookline, MA
  • NPI 1861118721
  NPD Authorized official
• DRS Burton Goldfarb & Daniel Goldfarb, DMD, PC

  • General Practice Dentistry
  • Brookline, MA
  • NPI 1447335518
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666483200000",
    "number": "1811538705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 TRAVELER ST UNIT 212",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182843",
            "telephone_number": "617-938-9161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 HARVARD ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024462938",
            "telephone_number": "617-277-1112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1842 Beacon St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Brookline",
            "state": "MA",
            "postal_code": "024451922",
            "country_code": "US",
            "telephone_number": "617-232-8113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "399 Belgrade Ave",
            "address_purpose": "LOCATION",
            "city": "West Roxbury",
            "state": "MA",
            "postal_code": "021321548",
            "country_code": "US",
            "telephone_number": "617-325-0101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1259 Hyde Park Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Hyde Park",
            "state": "MA",
            "postal_code": "021362817",
            "country_code": "US",
            "telephone_number": "617-364-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "USTAYEV",
        "first_name": "SAMUEL",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-02",
        "last_updated": "2022-10-23",
        "certification_date": "2022-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1858649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boris Urman, D.M.D.
• Sergey M. Urman, MD
• Jasmine Urquhart, CCC-SLP
• Cristina Urton, LMHC
• Mariya Usatina, PT MS
• Manju Vachher, PHD
• Erin Rose Vadala, MT-BC
• Viviane Valdes, PHD
• Remy Elizabeth Van Sanford, MD
• Cathy L Vandenheuvel, MD

• General Practice Dentistry in Brookline, MA
• Providers in Brookline, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.