Provider Demographics
NPI:1124494935
Name:SWARUP, AZEEZ GAURAV (DMD)
Entity type:Individual
Prefix:DR
First Name:AZEEZ
Middle Name:GAURAV
Last Name:SWARUP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2556
Mailing Address - Country:US
Mailing Address - Phone:978-368-0340
Mailing Address - Fax:978-368-1719
Practice Address - Street 1:650 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2060
Practice Address - Country:US
Practice Address - Phone:508-532-7318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857040122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice