Provider Demographics
NPI:1336562537
Name:SHANTI DENTAL PC
Entity Type:Organization
Organization Name:SHANTI DENTAL PC
Other - Org Name:SHANTI DENTAL SOMERSET
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOBICHETTYPALAYAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-980-4734
Mailing Address - Street 1:222 MILLIKEN BLVD
Mailing Address - Street 2:SUITE 5 3RD FLOOR
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1623
Mailing Address - Country:US
Mailing Address - Phone:508-672-7525
Mailing Address - Fax:
Practice Address - Street 1:481 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-5620
Practice Address - Country:US
Practice Address - Phone:508-679-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22099261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental