Provider Demographics
NPI:1710666052
Name:GENESIS DENTAL OF HAVERHILL PC
Entity Type:Organization
Organization Name:GENESIS DENTAL OF HAVERHILL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRERNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-641-7585
Mailing Address - Street 1:160 COMMANDANTS WAY APT 406
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-4044
Mailing Address - Country:US
Mailing Address - Phone:727-641-7585
Mailing Address - Fax:
Practice Address - Street 1:288 GROVELAND ST UNIT 3
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6669
Practice Address - Country:US
Practice Address - Phone:978-464-8446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental