Provider Demographics
NPI:1770183071
Name:COLCHESTER DENTAL, LLC
Entity Type:Organization
Organization Name:COLCHESTER DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABHAYJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-905-1882
Mailing Address - Street 1:2 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-2150
Mailing Address - Country:US
Mailing Address - Phone:978-422-1044
Mailing Address - Fax:
Practice Address - Street 1:106 HIGH POINT CTR STE 100
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8800
Practice Address - Country:US
Practice Address - Phone:802-655-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty