NPIMap

Individual provider Active NPI

Pedram Javedan, D.D.S.

  • Pediatric Dentistry
  • Cambridge, MA
National Provider Identifier
1821295452
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN1855617 Issued in MA
Practice address
575 Mount Auburn St
Suite 201
Cambridge, MA 02138-4656
Phone
(617) 383-4356
NPI assigned
Jun 28, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 053504 NY
Pediatric Dentistry 1223P0221X DN1855617 MA Primary

Addresses

Primary practice location

575 Mount Auburn St
Suite 201
Cambridge, MA 02138-4656

Mailing address

575 Mount Auburn St
Suite 201
Cambridge, MA 02138-4656
Phone (617) 383-4356

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

LicenseStateTypeSpecialty
DN1855617MAMDPediatric Dentist
053504NYMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Children'S Dentistry PC Pediatric Dentistry Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358899200000",
    "number": "1821295452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 MOUNT AUBURN ST",
            "address_2": "SUITE 201",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021384656",
            "telephone_number": "617-383-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 MOUNT AUBURN ST",
            "address_2": "SUITE 201",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021384656",
            "telephone_number": "617-383-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVEDAN",
        "first_name": "PEDRAM",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-28",
        "last_updated": "2013-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "053504",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1855617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.