Provider Demographics
NPI:1215693288
Name:GROTON FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:GROTON FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHAWATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-260-3083
Mailing Address - Street 1:2301 ARCHSTONE AVE APT 2301
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1864
Mailing Address - Country:US
Mailing Address - Phone:714-260-3083
Mailing Address - Fax:
Practice Address - Street 1:16 HOLLIS ST # A
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1386
Practice Address - Country:US
Practice Address - Phone:714-260-3083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental