Provider Demographics
NPI:1124490511
Name:HANDA, SHRUTI
Entity type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:HANDA
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 1:33 POND AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7136
Mailing Address - Country:US
Mailing Address - Phone:914-602-7837
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST STE 230
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-1076
Practice Address - Fax:877-789-6681
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist