Sanjay Reddy Bommu, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1856434 Issued in MA

Practice address

49 Cross Street Ext
Gardner, MA 01440-2209

Phone

(978) 632-5659

Fax

(978) 632-5713

NPI assigned

Dec 5, 2013

Last updated

Dec 5, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386201600000",
    "number": "1821429614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 CROSS STREET EXT",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014402209",
            "telephone_number": "978-632-5659",
            "fax_number": "978-632-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 CROSS STREET EXT",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014402209",
            "telephone_number": "978-632-5659",
            "fax_number": "978-632-5713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMU",
        "first_name": "SANJAY",
        "middle_name": "REDDY",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-05",
        "last_updated": "2013-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1856434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Andrew Blackman, PAC, ATC
• Stephen Charles Blais
• Jeffrey D. Blake, M.D.
• Julie Ann Blake, D.S.
• Rebecca Ann Blodgett, M.A., LMHC
• Jack R Borey
• Emily Bostock
• Debra Boucher
• Taylor K Boudreau, CNP
• Nannette D Bradley, LCSW

• General Practice Dentistry in Gardner, MA
• Providers in Gardner, 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 Dec 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.