Healthcare Provider Details

I. General information

NPI: 1427702802
Provider Name (Legal Business Name): ROUTE 9 DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOYLSTON ST STE L15
CHESTNUT HILL MA
02467-1715
US

IV. Provider business mailing address

28 ELIOT ST
CHESTNUT HILL MA
02467-1408
US

V. Phone/Fax

Practice location:
  • Phone: 617-612-5022
  • Fax:
Mailing address:
  • Phone: 617-612-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AMITA AGARWAL
Title or Position: OWNER
Credential: DDS
Phone: 617-612-5022