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General NPI Number Information
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NPI Number | 1710666052
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Entity Type | Organization
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Legal Business Name | GENESIS DENTAL OF HAVERHILL PC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 288 GROVELAND ST UNIT 3
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City | HAVERHILL
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State | MA
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Zip | 01830-6669
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Country | US
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Telephone | 978-464-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 160 COMMANDANTS WAY APT 406
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City | CHELSEA
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State | MA
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Zip | 02150-4044
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Country | US
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Telephone | 727-641-7585
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRERNA AGGARWAL
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Credential | DDS
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Telephone | 727-641-7585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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