Provider Demographics
NPI:1720573561
Name:HALLMARK DENTAL LEOMINSTER LLC
Entity Type:Organization
Organization Name:HALLMARK DENTAL LEOMINSTER LLC
Other - Org Name:HALLMARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:KROTHAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-223-1652
Mailing Address - Street 1:25 NASHUA RD UNIT D1
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3443
Mailing Address - Country:US
Mailing Address - Phone:617-223-1652
Mailing Address - Fax:
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3216
Practice Address - Country:US
Practice Address - Phone:978-534-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20845261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental