Provider Demographics
NPI:1568900884
Name:TYNGSBORO DENTAL CARE
Entity Type:Organization
Organization Name:TYNGSBORO DENTAL CARE
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:DDS
Authorized Official - Phone:978-259-5965
Mailing Address - Street 1:150 WESTFORD RD
Mailing Address - Street 2:#3
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2511
Mailing Address - Country:US
Mailing Address - Phone:978-259-5965
Mailing Address - Fax:
Practice Address - Street 1:41 RUSSELLS WAY
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886
Practice Address - Country:US
Practice Address - Phone:978-692-6827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty