Wilbraham Dental Associates, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21246 Issued in MA

Legal business name

WILBRAHAM DENTAL ASSOCIATES, LLC

Practice address

70 Post Office Park
Wilbraham, MA 01095-1290

Phone

(413) 279-2016

NPI assigned

Aug 29, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Christopher James Root, DMD FAGD

Title

Dentist/Owner

Phone

(413) 279-2016

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472428800000",
    "number": "1982150025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 POST OFFICE PARK",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951290",
            "telephone_number": "413-279-2016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 POST OFFICE PARK",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951290",
            "telephone_number": "413-279-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILBRAHAM DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-29",
        "last_updated": "2016-08-29",
        "status": "A",
        "authorized_official_last_name": "ROOT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "413-279-2016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD FAGD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "21246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110110523A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Wilbraham, MA
• Providers in Wilbraham, 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 Aug 29, 2016; 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.