Provider Demographics
NPI:1215500988
Name:MOHAN, SHREYA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHREYA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 NORTH RD UNIT 22
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1405
Mailing Address - Country:US
Mailing Address - Phone:978-319-0262
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER PL BLDG C
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1035
Practice Address - Country:US
Practice Address - Phone:978-458-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist