Active NPI
Edward Vance Geschelin, DMD
- General Practice Dentistry
- South Boston, MA
National Provider Identifier
1942202023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10573
- Practice address
- 500 E Broadway
South Boston, MA 02127-4406 - Phone
- (617) 268-2333
- Fax
- (617) 268-8894
- NPI assigned
- Jun 2, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10573 | MA | Primary |
Addresses
Primary practice location
500 E Broadway
South Boston, MA 02127-4406
Mailing address
500 E Broadway
South Boston, MA 02127-4406
Phone (617) 268-2333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0256897 | Medicaid | MA |
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 |
|---|---|---|---|
| 10573 | MA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sameka Dental Management | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- South Boston, MA
- NPI 1205015179
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202860800000",
"number": "1942202023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E BROADWAY",
"city": "SOUTH BOSTON",
"state": "MA",
"postal_code": "021274406",
"telephone_number": "617-268-2333",
"fax_number": "617-268-8894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E BROADWAY",
"city": "SOUTH BOSTON",
"state": "MA",
"postal_code": "021274406",
"telephone_number": "617-268-2333",
"fax_number": "617-268-8894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GESCHELIN",
"first_name": "EDWARD",
"middle_name": "VANCE",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-02",
"last_updated": "2008-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "10573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0256897",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.