NPIMap

Organization Active NPI

Irina Deresh

  • Dental Clinic/Center
  • Boston, MA
National Provider Identifier
1821274044
Registry record updated Jan 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
17846 Issued in MA
Legal business name
IRINA DERESH
Doing business as
TMD and Periodontal Associates
Practice address
396 Commonwealth Ave
Boston, MA 02215-2823
Phone
(617) 536-7720
Fax
(617) 536-8290
NPI assigned
Jan 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2008

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

Authorized official

Name
Dr. Irina Deresh, DMD
Title
President
Phone
(617) 536-7720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 17846 MA Primary

Addresses

Primary practice location

396 Commonwealth Ave
Boston, MA 02215-2823

Mailing address

396 Commonwealth Ave
Boston, MA 02215-2823
Phone (617) 536-7720

Other names 1

  • TMD and Periodontal Associates Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1821274044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "396 COMMONWEALTH AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152823",
            "telephone_number": "617-536-7720",
            "fax_number": "617-536-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 COMMONWEALTH AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022152823",
            "telephone_number": "617-536-7720",
            "fax_number": "617-536-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRINA DERESH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "DERESH",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-536-7720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "17846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TMD and Periodontal Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; 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.