Provider Demographics
NPI:1821388398
Name:DENTONIC
Entity Type:Organization
Organization Name:DENTONIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-697-7421
Mailing Address - Street 1:25 MIDDLESEX ROAD,
Mailing Address - Street 2:#2
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:781-697-7421
Mailing Address - Fax:781-647-1994
Practice Address - Street 1:25 MIDDLESEX RD
Practice Address - Street 2:#2
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-6170
Practice Address - Country:US
Practice Address - Phone:781-697-7421
Practice Address - Fax:781-647-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty