Provider Demographics
NPI:1780009779
Name:ARCH DENTAL CLINIC
Entity Type:Organization
Organization Name:ARCH DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANGANAYAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRUMAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-336-9767
Mailing Address - Street 1:200 WESTGATE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1810
Mailing Address - Country:US
Mailing Address - Phone:508-587-5333
Mailing Address - Fax:
Practice Address - Street 1:200 WESTGATE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1810
Practice Address - Country:US
Practice Address - Phone:508-587-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty