Excel Dental of Revere LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

EXCEL DENTAL OF REVERE LLC

Practice address

100 Squire Rd
Revere, MA 02151-1302

Phone

(781) 757-2488

Fax

(781) 757-2466

NPI assigned

Mar 26, 2024

Last updated

Mar 26, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Samir B Patel, CPA

Title

Managing Director

Phone

(781) 757-2488

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Maitree Patel

  • Dentist
  • Revere, MA
  • NPI 1346926185
  NPD
• Jampa Norbu

  • General Practice Dentistry
  • Revere, MA
  • NPI 1043024854
  NPD (past)

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1972353381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 GIANNA DR",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019061987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SQUIRE RD",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021511302",
            "telephone_number": "781-757-2488",
            "fax_number": "781-757-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL DENTAL OF REVERE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "781-757-2488",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Revere, MA
• Providers in Revere, 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 Mar 26, 2024; 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.