Michael L Eidelman, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16430 Issued in MA

Practice address

117 Lynn Street
Peabody, MA 01960

Phone

(978) 531-5100

NPI assigned

Aug 8, 2006

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

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972513323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 LYNN STREET",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "01960",
            "telephone_number": "978-531-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 LYNN STREET",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "01960",
            "telephone_number": "978-531-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDELMAN",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah A Dynan, P.T.
• Bobbi Dynice, OTR
• Bailey J Eastwood
• Mandy Egan
• Jaclyn Ehrhardt
• J. Michael Eisenhaur, BA
• Eric Ekelund, MS, LATC, CSCS
• Kerry Anne Elderkin
• Hiam Elias, DMD, PC
• Susan C. Elias, M.D.

• General Practice Dentistry in Peabody, MA
• Providers in Peabody, 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.