Blackstone Valley Dental Associates, LLC

Key facts

NPI

1962575571

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Dentistry 1223G0001X

License

16536 (MA)

Legal business name

BLACKSTONE VALLEY DENTAL ASSOCIATES, LLC

Practice address

12 Main St
Blackstone, MA 01504-2202

Phone

(508) 883-1050

Fax

(508) 883-0911

NPI assigned

Nov 15, 2006

Organization subpart

No

Authorized official

Name

Dr. Todd B Harris, D.M.D NPI 1558571836

Title

Manager

Phone

(508) 883-1050

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

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

• Todd Bruce Harris, D.M.D. General Practice Dentistry · Barnstable, MA · NPI 1558571836
  NPD (past) Authorized official GENERAL PRACTICE
• Demetrios E Galanis, DMD General Practice Dentistry · Blackstone, MA · NPI 1265506646
  NPD (past) GENERAL PRACTICE

National Provider Directory

Specialties & licenses

Addresses

Other names

• Blackstone Valley Dental Associates, P.C. Former legal business name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 22, 2008.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1962575571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 MAIN ST",
            "city": "BLACKSTONE",
            "state": "MA",
            "postal_code": "015042202",
            "telephone_number": "508-883-1050",
            "fax_number": "508-883-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 MAIN ST",
            "city": "BLACKSTONE",
            "state": "MA",
            "postal_code": "015042202",
            "telephone_number": "508-883-1050",
            "fax_number": "508-883-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSTONE VALLEY DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "508-883-1050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16536",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "19827",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackstone Valley Dental Associates, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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