Provider Demographics
NPI:1447595327
Name:AWASTHY, VINEET (DDS)
Entity Type:Individual
Prefix:
First Name:VINEET
Middle Name:
Last Name:AWASTHY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1103
Mailing Address - Country:US
Mailing Address - Phone:978-455-3775
Mailing Address - Fax:
Practice Address - Street 1:1673 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1103
Practice Address - Country:US
Practice Address - Phone:978-455-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 1856175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist