Provider Demographics
NPI:1730534603
Name:SUFFOLK DENTAL, PC
Entity type:Organization
Organization Name:SUFFOLK DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSHABH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-400-5920
Mailing Address - Street 1:85 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2939
Mailing Address - Country:US
Mailing Address - Phone:781-400-5920
Mailing Address - Fax:
Practice Address - Street 1:550 ALTA MERE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-4053
Practice Address - Country:US
Practice Address - Phone:781-400-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty