NPIMap

Organization Active NPI

Pediatric Dental Center of Mansfield

  • Dental Clinic/Center
  • Mansfield, MA
National Provider Identifier
1982876942
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
18512 Issued in MA
Legal business name
PEDIATRIC DENTAL CENTER OF MANSFIELD
Practice address
905B S Main St
Mansfield, MA 02048-3154
Phone
(508) 337-3307
Fax
(508) 337-3317
NPI assigned
Mar 31, 2008
Last updated
Mar 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Authorized official

Name
Robert J. Moreau, DMDNPI 1225160138
Title
Dentist
Phone
(508) 337-3307

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 18512 MA Primary

Addresses

Primary practice location

905B S Main St
Mansfield, MA 02048-3154

Mailing address

905B S Main St
Mansfield, MA 02048-3154
Phone (508) 337-3307

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dental Center of Mansfield2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

905B S Main St
Mansfield, MA 02048
Phone (508) 337-3307

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1982876942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905B S MAIN ST",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020483154",
            "telephone_number": "508-337-3307",
            "fax_number": "508-337-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905B S MAIN ST",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020483154",
            "telephone_number": "508-337-3307",
            "fax_number": "508-337-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL CENTER OF MANSFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "MOREAU",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "508-337-3307",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "18512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.