Provider Demographics
NPI:1528346939
Name:NORTH ACTON DENTAL
Entity type:Organization
Organization Name:NORTH ACTON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:NANDURI
Authorized Official - Last Name:JONNAVITHULA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-266-1614
Mailing Address - Street 1:255 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4739
Mailing Address - Country:US
Mailing Address - Phone:978-266-1614
Mailing Address - Fax:
Practice Address - Street 1:255 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4739
Practice Address - Country:US
Practice Address - Phone:978-266-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty