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General NPI Number Information
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NPI Number | 1770384463
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Entity Type | Organization
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Legal Business Name | DENTAL WELLNESS OF LOWELL
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1275 PAWTUCKET BLVD
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City | LOWELL
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State | MA
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Zip | 01854-1070
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Country | US
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Telephone | 781-209-5456
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Fax | 781-209-5859
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Provider Business Mailing Address
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Address Line | 1275 PAWTUCKET BLVD
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City | LOWELL
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State | MA
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Zip | 01854-1070
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Country | US
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Telephone | 781-209-5456
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Fax | 781-209-5859
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHANDRA MOHAN MANISH
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Credential | DMD
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Telephone | 603-738-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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