Provider Demographics
NPI:1629479506
Name:AGGARWAL, NEHA
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:AGGARWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DARTMOUTH ST
Mailing Address - Street 2:APT#609
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5112
Mailing Address - Country:US
Mailing Address - Phone:617-650-0247
Mailing Address - Fax:
Practice Address - Street 1:339 SQUIRE RD
Practice Address - Street 2:SUITE#150
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4309
Practice Address - Country:US
Practice Address - Phone:781-286-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18566961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice