Provider Demographics
NPI:1679776652
Name:HANOVER DENTAL PC
Entity type:Organization
Organization Name:HANOVER DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VASUDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-826-2961
Mailing Address - Street 1:225 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2208
Mailing Address - Country:US
Mailing Address - Phone:781-826-2961
Mailing Address - Fax:781-826-8346
Practice Address - Street 1:225 HANOVER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2208
Practice Address - Country:US
Practice Address - Phone:781-826-2961
Practice Address - Fax:781-826-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN20941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203670OtherMASS HEALTH