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General NPI Number Information
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NPI Number | 1376997734
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Entity Type | Organization
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Legal Business Name | RAGHAV SAI DENTAL
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 21 GEORGE ST 201
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City | LOWELL
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State | MA
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Zip | 01852-2228
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Country | US
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Telephone | 978-453-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 2 JACK RABBIT LN
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City | WESTFORD
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State | MA
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Zip | 01886-6804
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Country | US
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Telephone | 617-320-9858
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MS. MANJULA BATTALURI
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Credential | DMD
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Telephone | 978-853-8610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19616
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License Number State | MA
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