Provider Demographics
NPI:1972792083
Name:TEWKSBURY FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:TEWKSBURY FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARGHAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-851-8888
Mailing Address - Street 1:1120 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4739
Mailing Address - Country:US
Mailing Address - Phone:978-851-8888
Mailing Address - Fax:
Practice Address - Street 1:1120 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4739
Practice Address - Country:US
Practice Address - Phone:978-851-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental