Provider Demographics
NPI:1568855674
Name:PRIYANK TANEJA, DMD PC
Entity type:Organization
Organization Name:PRIYANK TANEJA, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYANK
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEJA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DMD, MMSC
Authorized Official - Phone:617-304-0060
Mailing Address - Street 1:745 BOYLSTON STREET STE #206
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2614
Mailing Address - Country:US
Mailing Address - Phone:617-536-4545
Mailing Address - Fax:
Practice Address - Street 1:745 BOYLSTON STREET
Practice Address - Street 2:SUITE #206
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-0211
Practice Address - Country:US
Practice Address - Phone:617-536-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN217041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty