Provider Demographics
NPI:1821645060
Name:WAVE DENTAL PLLC
Entity Type:Organization
Organization Name:WAVE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-834-0111
Mailing Address - Street 1:31 AMY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-6705
Mailing Address - Country:US
Mailing Address - Phone:617-834-0111
Mailing Address - Fax:
Practice Address - Street 1:281 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4623
Practice Address - Country:US
Practice Address - Phone:508-709-7750
Practice Address - Fax:508-433-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty