Healthcare Provider Details

I. General information

NPI: 1568741775
Provider Name (Legal Business Name): AVS DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37-39 W MAIN ST
GEORGETOWN MA
01833-2002
US

IV. Provider business mailing address

37-39 W MAIN ST
GEORGETOWN MA
01833-2002
US

V. Phone/Fax

Practice location:
  • Phone: 978-352-8400
  • Fax:
Mailing address:
  • Phone: 978-352-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21857
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SHRADHA SHARMA
Title or Position: DENTIST
Credential: DMD
Phone: 781-929-0595