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General NPI Number Information
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NPI Number | 1962062786
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND TMJ ASSOCIATES
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 376 MOODY ST
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City | WALTHAM
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State | MA
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Zip | 02453-5204
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Country | US
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Telephone | 617-588-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 26 NOBLE ST
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City | WEST NEWTON
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State | MA
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Zip | 02465-1016
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Country | US
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Telephone | 857-383-1140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHUCHI DHADWAL
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Credential | DMD
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Telephone | 857-383-1140
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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 |
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License Number State |
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