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MOUNT IDA COLLEGE NPI 1902929961


NPI Information

NPI: 1902929961
Provider Name: MOUNT IDA COLLEGE

Other Name: MOUNT IDA COLLEGE DENTAL CENTER

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
777 DEDHAM ST
NEWTON, MA
ZIP 02459
Phone: (617) 928-7360
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MOUNT IDA COLLEGE is a general practice dentist in Newton, MA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MOUNT IDA COLLEGE NPI is 1902929961. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Mount Ida College Dental Center.

The provider's business location address is:

777 DEDHAM ST
NEWTON, MA
ZIP 02459-323
Phone: (617) 928-7360
Fax: (617) 928-7030

The provider's authorized official is Gary Melvin Beckett .
The authorized official title is Supervising Dentist and has the following contact phone number (617) 928-7360.

The enumeration date for this NPI number is 4/6/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice15111MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10297658MEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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