1649742750 NPI number — ANSHUMAN S RAWAT DMD PC

Table of content: (NPI 1649742750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649742750 NPI number — ANSHUMAN S RAWAT DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANSHUMAN S RAWAT DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED DENTAL PRACTICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649742750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 EAST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WRENTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02093-1369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-384-3760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WRENTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02093-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-456-7111
Provider Business Practice Location Address Fax Number:
508-384-5083
Provider Enumeration Date:
12/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RAWAT
Authorized Official First Name:
ANSHUMAN
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
508-456-7111

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1598076325. . This is a "NPPES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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