Provider Demographics
NPI:1528193885
Name:NEHRA, SANJIV (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:
Last Name:NEHRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AMANDA RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2500
Mailing Address - Country:US
Mailing Address - Phone:617-833-7312
Mailing Address - Fax:
Practice Address - Street 1:222 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3902
Practice Address - Country:US
Practice Address - Phone:508-485-1800
Practice Address - Fax:508-485-1808
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice