1205269073 NPI number — FOR ALL AGES DENTAL ASSOCIATES

Table of content: MANWINDER SINGH SANDHU PT, DPT (NPI 1679134308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205269073 NPI number — FOR ALL AGES DENTAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOR ALL AGES DENTAL ASSOCIATES
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:
FOR ALL AGES FAMILY DENTAL
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:
1205269073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
478 TORREY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-4696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-586-1800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
478 TORREY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-4696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-586-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GIANNOS
Authorized Official First Name:
ROULA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-905-4395

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DN21173 , 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)





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