Provider Demographics
NPI:1346498193
Name:KRISHNAMOORTHI, PRITHVIRAJ (BDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:PRITHVIRAJ
Middle Name:
Last Name:KRISHNAMOORTHI
Suffix:
Gender:M
Credentials:BDS, MSD
Other - Prefix:DR
Other - First Name:PRITHVIRAJ
Other - Middle Name:
Other - Last Name:KRISHNAMOORTHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BDS, MSD
Mailing Address - Street 1:100 E NEWTON ST
Mailing Address - Street 2:AEGD, 7TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-4705
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:AEGD, 7TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist