Provider Demographics
NPI:1063739217
Name:HARVARD ST. DENTAL ASSOC,INC.PC
Entity type:Organization
Organization Name:HARVARD ST. DENTAL ASSOC,INC.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHOVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIRAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-232-6188
Mailing Address - Street 1:364 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2920
Mailing Address - Country:US
Mailing Address - Phone:617-232-6188
Mailing Address - Fax:617-232-6188
Practice Address - Street 1:364 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2920
Practice Address - Country:US
Practice Address - Phone:617-232-6188
Practice Address - Fax:617-232-6188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARVARD ST. DENTAL ASSOC,INC.PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty