Rafael Villacorta, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18063 Issued in MA

Practice address

24 Crescent St
Ste 303
Waltham, MA 02453

Phone

(781) 891-5637

Fax

(781) 891-8926

NPI assigned

Nov 9, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Rafael Villacorta Family Dentistry

  • Oral and Maxillofacial Pathology Dentistry
  • Waltham, MA
  • NPI 1700057346
  NPD (past) Authorized official

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952471708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST",
            "address_2": "STE 303",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-891-5637",
            "fax_number": "781-891-8926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 CRESCENT ST",
            "address_2": "STE 303",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-891-5637",
            "fax_number": "781-891-8926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLACORTA",
        "first_name": "RAFAEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "18063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9708049",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0274771",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Waltham, MA
• Providers in Waltham, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.