Provider Demographics
NPI:1154536621
Name:NEW ERA DENTAL
Entity type:Organization
Organization Name:NEW ERA DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE OWNER GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-576-6566
Mailing Address - Street 1:2400 MASSACHUSETTS AVE
Mailing Address - Street 2:1170 BEACON ST SUITE 110 BROOKLINE MA 02446
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1854
Mailing Address - Country:US
Mailing Address - Phone:617-576-6566
Mailing Address - Fax:617-576-3005
Practice Address - Street 1:2400 MASSACHUSETTS AVE
Practice Address - Street 2:1170 BEACON ST
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:617-576-6566
Practice Address - Fax:617-576-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19257122300000X
MA21256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1871501007OtherDR GOLI
MA1396869582OtherDR. GOHAR