NPIMap

Organization Active NPI

Shawsheen Family Dental

  • Dental Clinic/Center
  • Tewksbury, MA
National Provider Identifier
1982907762
Registry record updated Dec 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
20116 Issued in MA
Legal business name
SHAWSHEEN FAMILY DENTAL
Practice address
1455 Main St
Tewksbury, MA 01876-4769
Phone
(978) 851-7112
Fax
(978) 851-2811
NPI assigned
Dec 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2010

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

Authorized official

Name
Carla Bustillo-Gonzalez, D.D.S.NPI 1255450557
Title
Owner
Phone
(978) 851-7112

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 20116 MA Primary

Addresses

Primary practice location

1455 Main St
Tewksbury, MA 01876-4769

Mailing address

1455 Main St
Tewksbury, MA 01876-4769
Phone (978) 851-7112

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1982907762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 MAIN ST",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "018764769",
            "telephone_number": "978-851-7112",
            "fax_number": "978-851-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 MAIN ST",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "018764769",
            "telephone_number": "978-851-7112",
            "fax_number": "978-851-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWSHEEN FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2010-12-16",
        "status": "A",
        "authorized_official_last_name": "BUSTILLO-GONZALEZ",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-851-7112",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "20116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tewksbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; 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.