Provider Demographics
NPI:1306575824
Name:GOEL, PRERAK (DMD)
Entity type:Individual
Prefix:DR
First Name:PRERAK
Middle Name:
Last Name:GOEL
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 1:14 SARAH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1244
Mailing Address - Country:US
Mailing Address - Phone:508-353-5751
Mailing Address - Fax:
Practice Address - Street 1:109 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2112
Practice Address - Country:US
Practice Address - Phone:978-441-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist