Provider Demographics
NPI:1851813984
Name:MANTRAVADI, SHRUTI (DMD)
Entity type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:
Last Name:MANTRAVADI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2815
Mailing Address - Country:US
Mailing Address - Phone:347-463-3907
Mailing Address - Fax:
Practice Address - Street 1:260 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1319
Practice Address - Country:US
Practice Address - Phone:508-528-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03345122300000X
MA18576231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist