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NPI Code Detail

MEDICARE: AVON DENTAL GROUP, PLLC

MEDICARE: AVON DENTAL GROUP, PLLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1326688706
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVON DENTAL GROUP, PLLC
Provider Business Mailing Address
First Line : 907 MAIN ST
Second Line :
City : BROCKTON
State : MA
Zip : 02301-6629
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 747 W MAIN ST
Second Line :
City : AVON
State : MA
Zip : 02322-1746
Country : US
Telephone Number : 508-587-8300
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MRUGANK SARDHARA
Credential : DDS
Telephone Number : 508-588-1400
Provider Enumeration Date : 01/13/2020
Last Update Date : 01/13/2020

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Directions to “AVON DENTAL GROUP, PLLC ” Practice Location

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