MEDICARE: ADMIRE DENTAL FALL RIVER

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	:	1528685963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADMIRE DENTAL FALL RIVER

Provider Business Mailing Address
First Line	:	1480 S MAIN ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02724-2604
Country	:	US
Telephone Number	:	417-379-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 S MAIN ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02724-2604
Country	:	US
Telephone Number	:	417-379-7924
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	SATINDER JAWANDHA
Credential	:	DMD
Telephone Number	:	417-379-7924

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	07/01/2020

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