Active NPI
Kyle Matthew Edmonds, DDS
- Pediatric Dentistry
- Salem, MA
National Provider Identifier
1811567498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN1859792
- Practice address
- 600 Loring Hills Ave
8
Salem, MA 01970 - Phone
- (978) 910-0004
- NPI assigned
- Jun 28, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN1859792 | MA | Primary |
Addresses
Primary practice location
600 Loring Hills Ave
8
Salem, MA 01970
Mailing address
78 Kirkland St # 1
Cambridge, MA 02138-2033
Other practice location 1
6 Kimball Ln Ste 140
Lynnfield, MA 01940-2667
Phone (781) 334-8442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859792 | MA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broad Smiles LLC | Pediatric Dentistry | Current | Accepting new patients |
Locations
600 Loring Ave
Ste 8
Salem, MA 01970
Phone (978) 607-0062
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Salem, MA
- NPI 1831766211
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1811567498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 KIRKLAND ST # 1",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021382033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 LORING HILLS AVE",
"address_2": "8",
"city": "SALEM",
"state": "MA",
"postal_code": "01970",
"telephone_number": "978-910-0004"
}
],
"practiceLocations": [
{
"address_1": "6 Kimball Ln Ste 140",
"address_purpose": "LOCATION",
"city": "Lynnfield",
"state": "MA",
"postal_code": "019402667",
"country_code": "US",
"telephone_number": "781-334-8442",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EDMONDS",
"first_name": "KYLE",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-28",
"last_updated": "2023-09-11",
"certification_date": "2023-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DN1859792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.