NPIMap

Organization Active NPI

Wollaston Dental Care, Inc

  • Dentist
  • Quincy, MA
National Provider Identifier
1871765966
Registry record updated Mar 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
20147 Issued in MA
Legal business name
WOLLASTON DENTAL CARE, INC
Practice address
688 Hancock St
Quincy, MA 02170-2814
Phone
(617) 984-5888
Fax
(617) 984-5822
NPI assigned
Mar 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2008

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

Authorized official

Name
Jennifer Lee, DMD
Title
President
Phone
(617) 984-5888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 20147 MA Primary

Addresses

Primary practice location

688 Hancock St
Quincy, MA 02170-2814

Mailing address

688 Hancock St
Quincy, MA 02170-2814
Phone (617) 984-5888

Other identifiers 1

IdentifierTypeStateIssuer
X11526OtherMABLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Diamond Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

688 Hancock St
Quincy, MA 02170
Phone (617) 984-5888

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206662400000",
    "number": "1871765966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 HANCOCK ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021702814",
            "telephone_number": "617-984-5888",
            "fax_number": "617-984-5822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 HANCOCK ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021702814",
            "telephone_number": "617-984-5888",
            "fax_number": "617-984-5822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLLASTON DENTAL CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-28",
        "last_updated": "2008-03-28",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-984-5888",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "20147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "X11526",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2008; 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.