Healthcare Provider Details

I. General information

NPI: 1174352611
Provider Name (Legal Business Name): DIPTI MILIND WAKODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MACY ST # 2B
AMESBURY MA
01913-4315
US

IV. Provider business mailing address

345 E 24TH STREET
NEW YORK NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 978-893-3988
  • Fax:
Mailing address:
  • Phone: 212-998-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001574
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: