Reem Antun Lago, D.M.D. – Pediatric Dentistry

Key facts

NPI: 1831275627
Entity type: Individual (NPI type 1)
Primary specialty: Pediatric Dentistry 1223P0221X
License: 20782 (MA)
Practice address: 24 Lyman St Ste 240
Westborough, MA 01581-1483
Phone: (508) 366-0122
NPI assigned: Oct 27, 2006
Sex: Female
Sole proprietor: No

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.

The Dental Place General Practice Dentistry · Westborough, MA · NPI 1881614238

NPD (past) PEDIATRIC DENTISTRY

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
20782	MA	MD	Pediatric Dentist

Practice roles

Organization	Specialty	Status	New patients
The Dental Place	Pediatric Dentistry	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Dentistry	1223P0221X	20782	MA	Yes

Addresses

Primary practice location

24 Lyman St Ste 240
Westborough, MA 01581-1483

Mailing address

1005 Trapelo Rd Apt 4
Waltham, MA 02452-4875
Phone (781) 373-1171

Other identifiers

Identifier	Type	State	Issuer
ANX11834	Other	MA	BCBS MS
MOOX11834	Other	RI	BCBS RI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831275627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 TRAPELO RD APT 4",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024524875",
            "telephone_number": "781-373-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 LYMAN ST STE 240",
            "city": "WESTBOROUGH",
            "state": "MA",
            "postal_code": "015811483",
            "telephone_number": "508-366-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTUN LAGO",
        "first_name": "REEM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "20782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MS",
            "identifier": "ANX11834",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS RI",
            "identifier": "MOOX11834",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westborough, MA

All providers in Westborough, MA · Pediatric Dentistry in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.