Provider Demographics
NPI:1407607419
Name:DENTAL AESTHETICS OF LAWRENCE PLLC
Entity Type:Organization
Organization Name:DENTAL AESTHETICS OF LAWRENCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDNA
Authorized Official - Middle Name:SUDEEP
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-751-2929
Mailing Address - Street 1:606 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1027
Mailing Address - Country:US
Mailing Address - Phone:347-751-2929
Mailing Address - Fax:978-685-4028
Practice Address - Street 1:606 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1027
Practice Address - Country:US
Practice Address - Phone:347-751-2929
Practice Address - Fax:978-685-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty