MEDICARE: DGR DENTAL 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	:	1689264566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DGR DENTAL PC

Provider Business Mailing Address
First Line	:	23 BLACKTHORN RD
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-7731
Country	:	US
Telephone Number	:	732-668-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E MAIN ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-2690
Country	:	US
Telephone Number	:	732-668-1740
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HEMASUNDRA R DUGGIREDDY
Credential	:	DMD
Telephone Number	:	732-668-1740

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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