Healthcare Provider Details

I. General information

NPI: 1750402327
Provider Name (Legal Business Name): MEENAKSHY YEGNESWARAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLEASANT ST 201
WORCESTER MA
01609-3213
US

IV. Provider business mailing address

3 GREENWOOD ROAD
HOPKINTON MA
01748
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-2485
  • Fax:
Mailing address:
  • Phone: 508-435-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19764
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: