CAMBRIDGE PERIODONTICS LLC (NPI# 1790330298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790330298 |
| Entity Type | Organization |
| Organization Name | CAMBRIDGE PERIODONTICS LLC |
| Practice Address |
1692 Massachusetts Ave Ste 3 Cambridge MA 02138 |
| Practice Telephone | 6178645444 |
| Mailing Telephone | 6178645444 |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2019-08-02 |
| Authorized Official Name | MARK DERKAZARIAN (PERIODONTIST) |
| Authorized Official Telephone | 6178645444 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
1692 MASSACHUSETTS AVE STE 3 |
| City | CAMBRIDGE |
| State | MA |
| Zip Code | 02138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922618610 | Khushboo Vijay Bhatia | Student in an Organized Health Care Education/Training Program | Internal Medicine Residency Program, Mount Auburn Hospi, 330 Mt. Auburn Street, Cambridge, MA 02138 | 2020-08-06 |
| 1780204156 | Ashna Grover | Student in an Organized Health Care Education/Training Program | 330 Mt Auburn Street Mount Auburn Hospital, Internal Medicine Residency Program, Cambridge, MA 02138 | 2020-04-25 |
| 1295389765 | Yulia Levit | Technician/Technologist | 1208 Massachussets Av, Cambridge, MA 02138 | 2019-08-01 |
| 1720645393 | Chinmay Tusharkumar Jani | Student in an Organized Health Care Education/Training Program | Mount Auburn Hospital, 330 Mt Auburn Street, Cambridge, MA 02138 | 2019-05-20 |
| 1386209831 | Alexander Ryan Walker | Internal Medicine | 300 Mount Auburn Street Mount Auburn Hospital, Dept. of Medicine, Cambridge, MA 02138 | 2019-05-09 |
| 1659844868 | Aimee Hsieh | Social Worker | 525 Mount Auburn Street, Cambridge, MA 02138 | 2019-01-10 |
| 1043733389 | Armida Fruzzetti | Psychologist | 900 Concord Avenue, Cambridge, MA 02138 | 2017-07-19 |
| 1174984827 | Jenna Mezin Schmid | Psychologist | 75 Mt Auburn St 4 East, Harvard University Health Services, Cambridge, MA 02138 | 2016-03-09 |
| 1316313208 | Kelly Abbott | Optometrist | 12 Eliot St., Cambridge, MA 02138 | 2015-08-14 |
| 1750762548 | Armando Pardo | Dentist | 24 Peabody Terrace, Ap1602, Cambridge, MA 02138 | 2015-06-17 |
| Find all providers in zip 02138 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063809101 | Corneliu Sima | Dentist | 245 First St Ste 17, Forsyth Faculty Associates, Cambridge, MA 02142-1292 | 2015-04-15 |
| 1295971992 | Donna M. Ponte Pereira, Dmd, LLC | Dentist | 826 Cambridge St, Cambridge, MA 02141-1402 | 2008-12-30 |
| 1699944058 | Michael Todd Cwiklinski | Dentist | 4 Van Norden St, Apt. 1, Cambridge, MA 02140-2518 | 2008-02-29 |
| 1770770422 | Frank G Oppenheim | Dentist | 1692 Mass Ave, Cambridge, MA 02138-1803 | 2007-09-26 |
| 1437217064 | Bruce D Shoicket | Dentist | 1753 Massachusetts Avenue, Suite 2, Cambridge, MA 02140-2218 | 2006-12-05 |
| 1700896164 | Cambridge Periodontics | Dentist | 1692 Massachusetts Avenue, Cambridge, MA 02138 | 2006-08-09 |
| 1588133946 | Massachusetts Institute of Technology | Dentist | 25 Carleton St, Cambridge, MA 02142-1323 | 2018-11-15 |
| 1497045397 | Flavia R. Teles | Dentist | 245 First St, Cambridge, MA 02142-1200 | 2011-04-12 |
| 1982901997 | Thomas Elliott Vandyke | Dentist | 245 First St, Suite 1756, Cambridge, MA 02142-1200 | 2011-02-28 |
| 1184937682 | Patrick Shannon | Dentist | 1692 Massachusetts Ave, Cambridge, MA 02138-1878 | 2010-07-26 |
| Find all providers in CAMBRIDGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.