Individual provider Active NPI

John R Pallotta, DMD

  • General Practice Dentistry
  • Lexington, MA
National Provider Identifier
1871675199
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20614 Issued in MA
Practice address
19 Muzzey St
Ste 302
Lexington, MA 02421
Phone
(781) 861-9597
Fax
(781) 861-3536
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 20614 MA Primary

Addresses

Primary practice location

19 Muzzey St
Ste 302
Lexington, MA 02421

Mailing address

19 Muzzey St
Ste 302
Lexington, MA 02421
Phone (781) 861-9597

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160419000546 MA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 2961700331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20614MAMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871675199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MUZZEY ST",
            "address_2": "STE 302",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "02421",
            "telephone_number": "781-861-9597",
            "fax_number": "781-861-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 MUZZEY ST",
            "address_2": "STE 302",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "02421",
            "telephone_number": "781-861-9597",
            "fax_number": "781-861-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALLOTTA",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

Sources for this page

Verify at the official NPI Registry.