Provider Demographics
NPI:1063269140
Name:THAYAPARAN, THUVARAKA
Entity type:Individual
Prefix:
First Name:THUVARAKA
Middle Name:
Last Name:THAYAPARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAPLE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3849
Mailing Address - Country:US
Mailing Address - Phone:347-206-6615
Mailing Address - Fax:
Practice Address - Street 1:20 HOLLAND ST STE 400
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2749
Practice Address - Country:US
Practice Address - Phone:617-676-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2844122300000X
MADN100002551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist