Healthcare Provider Details

I. General information

NPI: 1699839639
Provider Name (Legal Business Name): ABHAYJIT S BEDI DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 AUBURN ST
AUBURN MA
01501-1635
US

IV. Provider business mailing address

176 AUBURN ST
AUBURN MA
01501-1635
US

V. Phone/Fax

Practice location:
  • Phone: 508-832-5731
  • Fax:
Mailing address:
  • Phone: 508-832-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number21056
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: