NPIMap

Organization Active NPI

Stanislav Kovtun, DMD PC

Doing business as Alpha Plus Dental Center

  • General Practice Dentistry
  • Brookline, MA
National Provider Identifier
1922462100
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
STANISLAV KOVTUN, DMD PC
Doing business as
Alpha Plus Dental Center
Practice address
185 Harvard St
Brookline, MA 02446
Phone
(617) 274-8494
Fax
(617) 277-7333
NPI assigned
Apr 13, 2016
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
Stanislav Kovtun, DMDNPI 1699112151
Title
President
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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X MA Primary

Addresses

Primary practice location

185 Harvard St
Brookline, MA 02446

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
110097248AMedicaidMA

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1922462100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 HARVARD ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "02446",
            "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 ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "02446",
            "telephone_number": "617-274-8494",
            "fax_number": "617-277-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANISLAV KOVTUN, DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "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": "PRESIDENT",
        "authorized_official_telephone_number": "617-277-6360",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110097248A",
            "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.