Provider Demographics
NPI:1689847121
Name:SANDHYA GOLI DMD, LLC
Entity Type:Organization
Organization Name:SANDHYA GOLI DMD, LLC
Other - Org Name:NEW ERA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-576-6566
Mailing Address - Street 1:2400 MASSACHUSETTS AVE
Mailing Address - Street 2:2D FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1854
Mailing Address - Country:US
Mailing Address - Phone:617-576-6566
Mailing Address - Fax:617-576-3005
Practice Address - Street 1:2400 MASSACHUSETTS AVE
Practice Address - Street 2:2D FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1854
Practice Address - Country:US
Practice Address - Phone:617-576-6566
Practice Address - Fax:617-576-3005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDHYA GOLI DMD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0280852Medicaid