Active NPI
Eugene Bark, DMD
- Dentist
- Brookline, MA
National Provider Identifier
1972648517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 20977
- Practice address
- 414 Harvard St
Brookline, MA 02446-2902 - Phone
- (617) 327-0600
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 20977 | MA | Primary |
Addresses
Primary practice location
414 Harvard St
Brookline, MA 02446-2902
Mailing address
414 Harvard St
Brookline, MA 02446-2902
Phone (617) 327-0600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0203122 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20977 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539734400000",
"number": "1972648517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 HARVARD ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462902",
"telephone_number": "617-327-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 HARVARD ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462902",
"telephone_number": "617-327-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARK",
"first_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-21",
"last_updated": "2018-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "20977",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0203122",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.