DR. GABRIEL BOUSTANI D.M.D., M.S.D.
NPI 1740216084
Dentist - Periodontics in Brookline, MA

Q: What is Gabriel Boustani's NPI number?

The NPI number for Gabriel Boustani is 1740216084. It was assigned to this individual provider in the NPPES registry on June 25, 2006.

Q: What is Gabriel Boustani's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Q: When was this NPI record last updated?

The NPPES record for Gabriel Boustani was last updated on January 23, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 25, 2006PECOS Enrolled

1540 BEACON ST, BROOKLINE, MA 02446(617) 738-1950 Get Directions Write a Review

NPPES record last updated: January 23, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Dr. Gabriel Boustani D.m.d., M.s.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GABRIEL BOUSTANI D.M.D., M.S.D. (NPI 1740216084) is an individual periodontics provider in Brookline, Massachusetts, licensed in Massachusetts (21631) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1740216084

Entity TypeIndividualMale

Primary Taxonomy1223P0300X

Provider Legal NameDR. GABRIEL BOUSTANICredential: D.M.D., M.S.D.

Location Address1540 BEACON STBrookline, MA 02446-2215

Mailing Address140 Greenwood StNewton, MA 02459-3013 · (617) 640-4637

Phone(617) 738-1950

Sole ProprietorNo

Enumeration DateJune 25, 2006

Last NPPES UpdateJanuary 23, 2015

✔ NPI 1740216084 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

License✔ Licensed in MA · 21631

Definition

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.

1540 BEACON ST, Brookline, MA 02446

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Sheld, Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Gabriel Boustani D.m.d., M.s.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02446 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$97.64 typical visit price

range $63.72 – $189.86

Typical copayment $24.41 (range $15.93 – $47.46)

Most-billed visit code 99203

Established Patient

$78.84 typical visit price

range $21.07 – $155.29

Typical copayment $19.71 (range $5.26 – $38.82)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JUSTINE R KELLEY DMD

Dentist (General Practice)