Active NPI
Mikaela An Brock, DMD
- General Practice Dentistry
- Boston, MA
National Provider Identifier
1891482220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN1859756
- Practice address
- 150 S Huntington Ave
Boston, MA 02130-4817 - Phone
- (617) 232-9500
- NPI assigned
- Apr 18, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN1859756 | MA | Primary |
Addresses
Primary practice location
150 S Huntington Ave
Boston, MA 02130-4817
Mailing address
15 Vernon St Apt 3
Brookline, MA 02446-4952
Phone (256) 804-8217
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859756 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707091200000",
"number": "1891482220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 VERNON ST APT 3",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024464952",
"telephone_number": "256-804-8217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S HUNTINGTON AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021304817",
"telephone_number": "617-232-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "MIKAELA",
"middle_name": "AN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-18",
"last_updated": "2024-02-05",
"certification_date": "2024-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1859756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.