MEDICARE: MEENAKSHY YEGNESWARAN DMD

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	122300000X	Dentist	19764	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750402327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEENAKSHY YEGNESWARAN DMD

Provider Business Mailing Address
First Line	:	3 GREENWOOD ROAD
Second Line	:
City	:	HOPKINTON
State	:	MA
Zip	:	01748
Country	:	US
Telephone Number	:	508-435-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PLEASANT ST
Second Line	:	201
City	:	WORCESTER
State	:	MA
Zip	:	01609-3213
Country	:	US
Telephone Number	:	508-752-2485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/16/2010

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