Provider Demographics
NPI:1215330386
Name:MOGRE, SAMMITA
Entity type:Individual
Prefix:
First Name:SAMMITA
Middle Name:
Last Name:MOGRE
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 1:434 SOUTHBRIDGE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-4423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:434 SOUTHBRIDGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-4423
Practice Address - Country:US
Practice Address - Phone:774-243-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist