Healthcare Provider Details

I. General information

NPI: 1770384463
Provider Name (Legal Business Name): DENTAL WELLNESS OF LOWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 PAWTUCKET BLVD
LOWELL MA
01854-1070
US

IV. Provider business mailing address

1275 PAWTUCKET BLVD
LOWELL MA
01854-1070
US

V. Phone/Fax

Practice location:
  • Phone: 781-209-5456
  • Fax: 781-209-5859
Mailing address:
  • Phone: 781-209-5456
  • Fax: 781-209-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANDRA MOHAN MANISH
Title or Position: OWNER
Credential: DMD
Phone: 603-738-6808