Active NPI
Minsub Ban, DDS
- Dentist
- Athol, MA
National Provider Identifier
1912740598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN10000417
- Practice address
- 546 Main St
Athol, MA 01331-1821 - Phone
- (978) 830-4610
- NPI assigned
- Jun 13, 2024
- Last updated
- Nov 2, 2024
- Sex
- Male
- 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 | DN10000417 | MA | Primary |
Addresses
Primary practice location
546 Main St
Athol, MA 01331-1821
Mailing address
4042 Guinea Rd
Fairfax, VA 22032-1413
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 |
|---|---|---|---|
| DN10000417 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quabbin Valley Dental PC | Current | Accepting new patients | |
| QVD LLC | Past | Accepting new patients |
Locations
546 Main St
Athol, MA 01331
Phone (978) 830-4610
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Athol, MA
- NPI 1437865896
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730505600000",
"number": "1912740598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4042 GUINEA RD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220321413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "546 MAIN ST",
"city": "ATHOL",
"state": "MA",
"postal_code": "013311821",
"telephone_number": "978-830-4610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAN",
"first_name": "MINSUB",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-13",
"last_updated": "2024-11-02",
"certification_date": "2024-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DN10000417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athol, MA
- Athol Memorial Hospital Incorporated (Athol Memorial Hospital)
- Athol Memorial Hospital Incorporated (Athol Primary Care)
- Athol Pharmacy, LLC (Athol Pharmacy)
- Athol Pharmacy, LLC (Athol Pharmacy)
- Athol Royalston Regional School District
- Colleen Ada Bannister
- Ying Bao
- Katrina Brooke Barnes, LPN
- Susan Jane Barnes, MED CCC SLP
- Ryan Barry
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.