Provider Demographics
NPI:1568017366
Name:UNITY DENTAL ROSLINDALE PC
Entity Type:Organization
Organization Name:UNITY DENTAL ROSLINDALE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARAKESWAR REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VONGURU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-816-1759
Mailing Address - Street 1:12 QUARRY LN APT 3416
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7775
Mailing Address - Country:US
Mailing Address - Phone:617-816-1759
Mailing Address - Fax:
Practice Address - Street 1:4172 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1730
Practice Address - Country:US
Practice Address - Phone:617-816-1759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental