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General NPI Number Information
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NPI Number | 1871732123
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Entity Type | Organization
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Legal Business Name | DENTAL QUEST INC
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 1275 PAWTUCKET BLVD SUIT#1
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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 | 978-458-3456
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Fax | 978-923-7906
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Provider Business Mailing Address
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Address Line | 1275 PAWTUCKET BLVD SUIT#1
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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 | 978-458-3456
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Fax | 978-923-7906
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Authorized Official
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Title or Position | DOCTOR
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Name | MAMATHA POLAVARAPU
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Credential | DMD
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Telephone | 978-458-3456
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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 | 20435
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License Number State | MA
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