Provider Demographics
NPI:1508268418
Name:TRIDENT DENTAL CARE PC
Entity Type:Organization
Organization Name:TRIDENT DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTULA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-556-0609
Mailing Address - Street 1:16 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3911
Mailing Address - Country:US
Mailing Address - Phone:508-556-0609
Mailing Address - Fax:
Practice Address - Street 1:16 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3911
Practice Address - Country:US
Practice Address - Phone:508-556-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty