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General NPI Number Information
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NPI Number | 1851813984
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Entity Type | Individual
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Provider Name | SHRUTI MANTRAVADI DMD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 260 E CENTRAL ST
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City | FRANKLIN
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State | MA
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Zip | 02038-1319
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Country | US
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Telephone | 508-528-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 28 WAYSIDE DR
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City | HOPKINTON
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State | MA
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Zip | 01748-2815
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Country | US
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Telephone | 347-463-3907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 03345
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1857623
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License Number State | MA
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