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General NPI Number Information
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NPI Number | 1720573561
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Entity Type | Organization
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Legal Business Name | HALLMARK DENTAL LEOMINSTER LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 23 WATER ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-3216
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Country | US
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Telephone | 978-534-4981
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Fax |
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Provider Business Mailing Address
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Address Line | 25 NASHUA RD UNIT D1
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City | LONDONDERRY
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State | NH
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Zip | 03053-3443
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Country | US
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Telephone | 617-223-1652
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DR. NANARAO KROTHAPALLI
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Credential | DMD
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Telephone | 617-223-1652
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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 | 20845
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License Number State | MA
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