=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710855291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTIVERSE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2025
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 DRUM HILL RD
-----------------------------------------------------
City | CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01824-1503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-756-7777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 FOX MEADOW DR
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02090-1155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KUSH PATEL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 857-756-7777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------