Provider Demographics
NPI:1972354918
Name:DENTAL WELLNESS OF WALTHAM
Entity Type:Organization
Organization Name:DENTAL WELLNESS OF WALTHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANISH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-738-6808
Mailing Address - Street 1:7 WESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1538
Mailing Address - Country:US
Mailing Address - Phone:603-738-6808
Mailing Address - Fax:
Practice Address - Street 1:475 WINTER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1213
Practice Address - Country:US
Practice Address - Phone:603-738-6808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty