Provider Demographics
NPI:1851602445
Name:ADVANCED DENTISTRY LLC
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY LLC
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-933-3448
Mailing Address - Street 1:65 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6711
Mailing Address - Country:US
Mailing Address - Phone:781-933-3448
Mailing Address - Fax:781-933-3436
Practice Address - Street 1:65 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6711
Practice Address - Country:US
Practice Address - Phone:781-933-3448
Practice Address - Fax:781-933-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19257261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental