Provider Demographics
NPI:1649742750
Name:ANSHUMAN S RAWAT DMD PC
Entity Type:Organization
Organization Name:ANSHUMAN S RAWAT DMD PC
Other - Org Name:ADVANCED DENTAL PRACTICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSHUMAN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:RAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-456-7111
Mailing Address - Street 1:21 EAST ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1369
Mailing Address - Country:US
Mailing Address - Phone:508-384-3760
Mailing Address - Fax:
Practice Address - Street 1:21 EAST ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1369
Practice Address - Country:US
Practice Address - Phone:508-456-7111
Practice Address - Fax:508-384-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1598076325.OtherNPPES