Provider Demographics
NPI:1730468430
Name:ANDOVER FAMILY DENTAL
Entity Type:Organization
Organization Name:ANDOVER FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-434-1385
Mailing Address - Street 1:16 HAVERHILL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3000
Mailing Address - Country:US
Mailing Address - Phone:978-470-2233
Mailing Address - Fax:978-470-2212
Practice Address - Street 1:16 HAVERHILL ST STE 1
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3000
Practice Address - Country:US
Practice Address - Phone:978-470-2233
Practice Address - Fax:978-470-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty