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General NPI Number Information
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NPI Number | 1447647870
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Entity Type | Organization
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Legal Business Name | A V RAWAT PC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 116 PROVIDENCE HWY
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City | EAST WALPOLE
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State | MA
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Zip | 02032-1509
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Country | US
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Telephone | 508-734-3200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANSHUMAN RAWAT
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Credential | DMD
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Telephone | 508-734-3200
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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 | 1855200
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License Number State | MA
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