Provider Demographics
NPI:1811049190
Name:FAMILY DENTAL GROUP OF PAXTON
Entity type:Organization
Organization Name:FAMILY DENTAL GROUP OF PAXTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-755-2905
Mailing Address - Street 1:35 MORELAND GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1075
Mailing Address - Country:US
Mailing Address - Phone:508-752-9921
Mailing Address - Fax:
Practice Address - Street 1:581 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1382
Practice Address - Country:US
Practice Address - Phone:508-755-2905
Practice Address - Fax:508-798-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty