MEDICARE: MAYA MUTHUSWAMY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184330250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYA MUTHUSWAMY PC

Provider Business Mailing Address
First Line	:	629 MASSACHUSETTS AVE
Second Line	:
City	:	BOXBOROUGH
State	:	MA
Zip	:	01719-1528
Country	:	US
Telephone Number	:	857-526-2559
Fax Number	:

Provider Business Practice Location Address
First Line	:	629 MASSACHUSETTS AVE
Second Line	:
City	:	BOXBOROUGH
State	:	MA
Zip	:	01719-1528
Country	:	US
Telephone Number	:	857-526-2559
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	MAYA MUTHUSWAMY
Credential	:	DMD
Telephone Number	:	857-526-2559

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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