=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720891989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GSK DENTAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 CAMBRIDGE ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02141-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-632-3845
-----------------------------------------------------
Fax | 978-276-9900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 NAVILLUS RD
-----------------------------------------------------
City | NORTH READING
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01864-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-632-3845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ DIRECTOR
-----------------------------------------------------
Name | DR. SHARANJOT MANN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 909-632-3845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------