Active NPI
Melba Dietrich, DDS
- Dentist
- Lynn, MA
National Provider Identifier
1902053259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10167
- Practice address
- 269 Union Street
Lynn, MA 01913-1314 - Phone
- (781) 596-2502
- Fax
- (781) 596-3966
- NPI assigned
- Aug 19, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10167 | MA | Primary |
Addresses
Primary practice location
269 Union Street
Lynn, MA 01913-1314
Mailing address
269 Union Street
Lynn Community Health Center
Lynn, MA 01913-1314
Phone (781) 596-2502
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160523001823 | MA | Order and Referring Only - Dentist | 2769771229 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10167 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219104000000",
"number": "1902053259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 UNION STREET",
"address_2": "LYNN COMMUNITY HEALTH CENTER",
"city": "LYNN",
"state": "MA",
"postal_code": "019131314",
"telephone_number": "781-596-2502",
"fax_number": "781-596-3966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "269 UNION STREET",
"city": "LYNN",
"state": "MA",
"postal_code": "019131314",
"telephone_number": "781-596-2502",
"fax_number": "781-596-3966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "MELBA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-19",
"last_updated": "2008-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "10167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.