NPIMap

Organization Active NPI

Stanislav Kovtun DMD, PC

  • Dentist
  • Brookline, MA
National Provider Identifier
1902931686
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN1856247 Issued in MA
Legal business name
STANISLAV KOVTUN DMD, PC
Practice address
185 Harvard Street
Brookline, MA 02446-5013
Phone
(617) 274-8494
Fax
(617) 277-7333
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

Name
Dr. Stanislav Kovtun, DMDNPI 1699112151
Title
Owner
Phone
(617) 277-6360

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN1856247 MA Primary

Addresses

Primary practice location

185 Harvard Street
Brookline, MA 02446-5013

Mailing address

185 Harvard Street
Brookline, MA 02446-5013
Phone (617) 277-6360

Other identifiers 1

IdentifierTypeStateIssuer
0278238MedicaidMA

Other names 1

  • Alpha Plus Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alpha Plus Dental Center2 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

185 Harvard St
Brookline, MA 02446
Phone (617) 274-8494

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": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1902931686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 HARVARD STREET",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465013",
            "telephone_number": "617-277-6360",
            "fax_number": "617-277-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 HARVARD STREET",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465013",
            "telephone_number": "617-274-8494",
            "fax_number": "617-277-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANISLAV KOVTUN DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "KOVTUN",
        "authorized_official_first_name": "STANISLAV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-277-6360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0278238",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alpha Plus Dental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alpha Plus Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookline, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.