Provider Demographics
NPI:1417697046
Name:ANGEL RAY PC
Entity Type:Organization
Organization Name:ANGEL RAY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-492-8429
Mailing Address - Street 1:17 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7010
Mailing Address - Country:US
Mailing Address - Phone:781-492-8429
Mailing Address - Fax:
Practice Address - Street 1:46 FARNSWORTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1211
Practice Address - Country:US
Practice Address - Phone:617-259-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty