NPI 1619351269

Venusdentalpc

Organisation Preferred Provider Organization Maynard, MA

Practice location

Address: 63 Great Rd STE 105, Maynard, MA 01754-2097
Phone: (978) 298-5281

Authorised official

Name: Azadeh Shahab
Title: Dentistowner
Phone: (978) 298-5281

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence DN1856317 (MA)

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Registry record

NPI: 1619351269
Entity type: Organization
NPI issued: 14 Jul 2015
Record last updated: 14 Jul 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.