BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY — NPI 1093993503 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in BOSTON, MA)

CMS-1500 Box 24J / 33a • NPI

1093993503

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223P0106X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

100 E NEWTON ST, RM G-04, BOSTON, MA, 02118-2308

✓ 9-Digit EDI 837 ZIP+4 (02118-2308)

Practice Phone & Referral Fax

(617) 638-4775

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093993503 (BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093993503` (NPI-2 Organization / Facility)
Provider / Legal Name	BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223P0106X` (Dentist, Oral and Maxillofacial Pathology)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	100 E NEWTON ST, RM G-04, BOSTON, MA, 02118-2308
Practice Telephone / Fax	Tel: (617) 638-4775
Administrative Mailing Address	PO BOX 1167, MARBLEHEAD, MA, 01945
Enumeration & Last Sync	Enumerated: 2008-02-06 \| CMS Record Updated: 2008-02-06
Authorized Official	JEFFREY HUTTER (Dean ad interim)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

100 E NEWTON ST, RM G-04, BOSTON, MA, 02118-2308

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Plain-English Taxonomy & CMS Crosswalk (1223P0106X)

What Does Taxonomy Code 1223P0106X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223P0106X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223P0106X` — Dentist, Oral and Maxillofacial Pathology Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: MA \| License: `4954` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY (NPI #1093993503)