Provider Demographics
NPI:1093282493
Name:MILFORD DENTIST OFFICE, PC
Entity Type:Organization
Organization Name:MILFORD DENTIST OFFICE, PC
Other - Org Name:MILFORD DENTIST OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHOKKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-325-1091
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8500
Mailing Address - Fax:
Practice Address - Street 1:128 MEDWAY RD STE 2&3
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2915
Practice Address - Country:US
Practice Address - Phone:781-325-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty