MEDICARE: ANGEL RAY 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
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1770470635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL RAY PC

Provider Business Mailing Address
First Line	:	1104 COMMONWEALTH AVE
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1448
Country	:	US
Telephone Number	:	781-492-8429
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 MAIN ST
Second Line	:
City	:	NORTH READING
State	:	MA
Zip	:	01864-1367
Country	:	US
Telephone Number	:	978-664-5901
Fax Number	:

Authorized Official
Title or Position	:	EMPLOYEE
Name	:	DR. DIVYA BHARGAVA
Credential	:	D.M.D
Telephone Number	:	781-492-8429

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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Directions to “ANGEL RAY PC ” Practice Location

Language	Start Address	Practice Location

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