Provider Demographics
NPI:1548743776
Name:WESTFORD FAMILY DENTAL
Entity Type:Organization
Organization Name:WESTFORD FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHURIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-344-4746
Mailing Address - Street 1:174 LITTLETON RD # 19
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3191
Mailing Address - Country:US
Mailing Address - Phone:978-392-0111
Mailing Address - Fax:
Practice Address - Street 1:174 LITTLETON RD # 19
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3191
Practice Address - Country:US
Practice Address - Phone:978-392-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental