Centralmassdentalgroup PC

Key facts

NPI

1972106433

Entity type

Organization (NPI type 2)

Primary specialty

Dental Clinic/Center 261QD0000X

Legal business name

CENTRALMASSDENTALGROUP PC

Practice address

38 Exchange St
Athol, MA 01331-1812

Phone

(978) 249-8545

NPI assigned

Nov 18, 2020

Organization subpart

No

Authorized official

Name

Dr. Dong Won Kim, DMD

Title

Owner

Phone

(617) 888-3400

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

• Centralmassdentalgroup PC Dental Clinic/Center · Orange, MA · NPI 1548863947
  NPD tax ID
• Centralmassdentalgroup PC Dental Clinic/Center · Gardner, MA · NPI 1558964957
  NPD tax ID

National Provider Directory

Tax ID family

Centralmassdentalgroup PC (3 organizations share this tax ID)

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 18, 2020.

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1972106433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 EXCHANGE ST",
            "city": "ATHOL",
            "state": "MA",
            "postal_code": "013311812",
            "telephone_number": "978-249-8545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 EXCHANGE ST",
            "city": "ATHOL",
            "state": "MA",
            "postal_code": "013311812",
            "telephone_number": "978-249-8545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Grove St",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "MA",
            "postal_code": "013641009",
            "country_code": "US",
            "telephone_number": "978-544-3515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "49 Cross St",
            "address_purpose": "LOCATION",
            "city": "Gardner",
            "state": "MA",
            "postal_code": "014402213",
            "country_code": "US",
            "telephone_number": "978-632-5659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRALMASSDENTALGROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DONG",
        "authorized_official_middle_name": "WON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-888-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athol, MA

• Meaghan Elizabeth Carr, M.A.
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• Carrie-Anne Hale Case, N.P.
• Castro Nyame
• Linda Change
• Scott Chastain, M.S.
• Deborah Jean Chickering, LICSW
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All providers in Athol, MA · Dental Clinic/Center in Massachusetts