1790112159 NPI number — MISS AMRITA MALHOTRA DDS

Table of content: MISS AMRITA MALHOTRA DDS (NPI 1790112159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790112159 NPI number — MISS AMRITA MALHOTRA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALHOTRA
Provider First Name:
AMRITA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1790112159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 BOYLSTON ST UNIT 1409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-971-7589
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 KNEELAND ST
Provider Second Line Business Practice Location Address:
TUFTS UNIVERSITY 5TH FLOOR IMPLANT CENTER
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02111-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-636-6930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DL12071 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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