Provider Demographics
NPI:1013483254
Name:GLOBAL DENTAL P.C
Entity Type:Organization
Organization Name:GLOBAL DENTAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VENU
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-301-8655
Mailing Address - Street 1:58 TEA PARTY WAY
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1980
Mailing Address - Country:US
Mailing Address - Phone:215-301-8655
Mailing Address - Fax:
Practice Address - Street 1:439 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3612
Practice Address - Country:US
Practice Address - Phone:215-301-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental