Revere Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN20603 Issued in MA

Legal business name

REVERE PEDIATRIC DENTISTRY

Practice address

11 Vinal St
Revere, MA 02151-5326

Phone

(781) 284-3113

NPI assigned

Jun 16, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kamar Maria Baloul, DMD

Title

Pediatric Dentist

Phone

(781) 284-3113

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jasmin Koleini, DDS

  • Pediatric Dentistry
  • Revere, MA
  • NPI 1528624574
  NPD (past)

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1912357336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 VINAL ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515326",
            "telephone_number": "781-284-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 VINAL ST",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515326",
            "telephone_number": "781-284-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "BALOUL",
        "authorized_official_first_name": "KAMAR",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "781-284-3113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN20603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Revere Adult Day Health Care
• Revere Dental and Orthodontics PC
• Revere Dentistry and Braces LLC
• Revere Health Center Pharmacy
• Revere Homecare Services
• Revere Physical Therapy
• Revere Rehab, Inc.
• Revere Rehabilitation Center
• Revere Winthrop Pediatrics
• Jessica Rothwell Richard, M.S., P.T.

• Pediatric Dentistry in Revere, MA
• Providers in Revere, MA by specialty
• Pediatric Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; 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.