NPIMap

Organization Active NPI

Dr. Fardad Mobed, P.C.

  • Endodontics
  • Revere, MA
National Provider Identifier
1912166141
Registry record updated Jun 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
18187 Issued in MA
Legal business name
DR. FARDAD MOBED, P.C.
Practice address
603 Broadway
Revere, MA 02151-3045
Phone
(781) 289-3600
NPI assigned
Jun 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2008

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

Authorized official

Name
Dr. Fardad MobedNPI 1912027293
Title
Owner
Phone
(781) 289-3600

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 18187 MA Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 18187 MA

Addresses

Primary practice location

603 Broadway
Revere, MA 02151-3045

Mailing address

603 Broadway
Revere, MA 02151-3045
Phone (781) 289-3600

Other names 1

  • Northgate Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

603 Broadway
Revere, MA 02151
Phone (781) 289-3600

Practitioners & affiliated clinicians

Practitioners 2

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": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1912166141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513045",
            "telephone_number": "781-289-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513045",
            "telephone_number": "781-289-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. FARDAD MOBED, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "MOBED",
        "authorized_official_first_name": "FARDAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-289-3600",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MA",
            "license": "18187",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18187",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northgate Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.