Healthcare Provider Details

I. General information

NPI: 1770470635
Provider Name (Legal Business Name): ANGEL RAY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MAIN ST
NORTH READING MA
01864-1367
US

IV. Provider business mailing address

1104 COMMONWEALTH AVE
NEWTON MA
02459-1448
US

V. Phone/Fax

Practice location:
  • Phone: 978-664-5901
  • Fax:
Mailing address:
  • Phone: 781-492-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DIVYA BHARGAVA
Title or Position: EMPLOYEE
Credential: D.M.D
Phone: 781-492-8429