Provider Demographics
NPI:1568514883
Name:MPGT CORP
Entity Type:Organization
Organization Name:MPGT CORP
Other - Org Name:NEW ENGLAND DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GOKULAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THIAGARAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-485-1114
Mailing Address - Street 1:661C BOSTON POST RD E
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3732
Mailing Address - Country:US
Mailing Address - Phone:508-485-1114
Mailing Address - Fax:508-480-8434
Practice Address - Street 1:661 BOSTON POST RD E STE C
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3732
Practice Address - Country:US
Practice Address - Phone:508-485-1114
Practice Address - Fax:508-480-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty