Healthcare Provider Details

I. General information

NPI: 1356271936
Provider Name (Legal Business Name): DENTAL WELLNESS OF EVERETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MAIN ST
EVERETT MA
02149-5719
US

IV. Provider business mailing address

285 MAIN ST
EVERETT MA
02149-5719
US

V. Phone/Fax

Practice location:
  • Phone: 617-207-0705
  • Fax:
Mailing address:
  • Phone: 617-207-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANDRA MOHAN MANISH
Title or Position: OWNER
Credential: DMD
Phone: 978-458-3456