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General NPI Number Information
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NPI Number | 1194234518
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY DENTAL CARE PC
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 1168 LAKEVIEW #3,
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City | DRACUT
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State | MA
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Zip | 01826
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Country | US
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Telephone | 978-957-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 1168 LAKEVIEW AVE STE 3
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City | DRACUT
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State | MA
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Zip | 01826-4763
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NAYAKI GADDIPATI
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Credential |
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Telephone | 214-336-9767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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