Citidental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

18609 Issued in MA

Legal business name

CITIDENTAL, LLC

Practice address

63 Court St
Boston, MA 02108-2109

Phone

(617) 723-6300

Fax

(617) 723-1717

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Peyman Khadivi, DDS

Title

Owner

Phone

(617) 723-6300

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831390368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 COURT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021082109",
            "telephone_number": "617-723-6300",
            "fax_number": "617-723-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 COURT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021082109",
            "telephone_number": "617-723-6300",
            "fax_number": "617-723-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIDENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHADIVI",
        "authorized_official_first_name": "PEYMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-723-6300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "18609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "X12378",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1725478",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Flather-Morgan Cist, MD
• Alexandra Cisto, DPT
• Michelle Jean Ciszewski, MS, APRN-BC, ANP
• Citidenta Tremont PLLC
• Citidental PC
• City of Boston
• Cityblock Medical Practice Ma, PC
• Citywide Home Care, Inc.
• John Thomas Ciufo Jr., RPH
• Viesha Ciura, M.D.

• Dentist in Boston, MA
• Providers in Boston, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.