Healthcare Provider Details

I. General information

NPI: 1346947660
Provider Name (Legal Business Name): NEEDHAM DENTISTRY & IMPLANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CHESTNUT ST
NEEDHAM MA
02492-2576
US

IV. Provider business mailing address

20 CHESTNUT ST
NEEDHAM MA
02492-2576
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-4647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAM P YADAV
Title or Position: OWNER
Credential:
Phone: 573-639-0497