REVERE PEDIATRIC DENTISTRY
NPI 1912357336
Dentist - Pediatric Dentistry in Revere, MA

Active since June 16, 2016

NPPES record last updated: June 16, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Revere Pediatric Dentistry NPPES

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

REVERE PEDIATRIC DENTISTRY (NPI 1912357336) is a healthcare organization registered as a pediatric dentistry in Revere, Massachusetts and active in the NPI registry since June 2016. The organization lists Kamar Maria Baloul, Pediatric Dentist, as its authorized official.

NPPES Registry Identity

NPI1912357336
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameREVERE PEDIATRIC DENTISTRY
Location Address11 VINAL STRevere, MA 02151-5326
Mailing Address11 Vinal StRevere, MA 02151-5326 · (781) 284-3113
Organization SubpartNo
Authorized OfficialKamar Maria BaloulPediatric Dentist · (781) 284-3113
Enumeration DateJune 16, 2016
NPI 1912357336 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License Licensed in MA · DN20603
Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

11 VINAL ST, Revere, MA 02151

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

Dentist (Pediatric Dentistry)
11 VINAL ST
REVERE, MA 02151

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revere Pediatric Dentistry's NPI number?

The NPI number for Revere Pediatric Dentistry is 1912357336. It was assigned to this organization in the NPPES registry on June 16, 2016.

Where is Revere Pediatric Dentistry located?

Revere Pediatric Dentistry is located at 11 Vinal St, Revere, MA 02151. The listed phone number is (781) 284-3113.

What is Revere Pediatric Dentistry's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Revere Pediatric Dentistry was last updated on June 16, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.