Provider Demographics
NPI:1427373463
Name:GLOBUS DENTAL CARE CENTER AT MATTAPAN
Entity Type:Organization
Organization Name:GLOBUS DENTAL CARE CENTER AT MATTAPAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANGANAYAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRUMAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-336-9767
Mailing Address - Street 1:1634 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2121
Mailing Address - Country:US
Mailing Address - Phone:617-298-2000
Mailing Address - Fax:
Practice Address - Street 1:1634 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2121
Practice Address - Country:US
Practice Address - Phone:617-298-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty