Provider Demographics
NPI:1154097434
Name:EXCEL DENTAL OF EVERETT, LLC
Entity Type:Organization
Organization Name:EXCEL DENTAL OF EVERETT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITRANG
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-433-8060
Mailing Address - Street 1:1795 REVERE BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5912
Mailing Address - Country:US
Mailing Address - Phone:617-433-8060
Mailing Address - Fax:
Practice Address - Street 1:1795 REVERE BEACH PKWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5912
Practice Address - Country:US
Practice Address - Phone:617-433-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental