Organization
REVERE DENTAL AND ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEETU BANSAL DMD (OWNER)
(617) 275-6306
Entity
Organization
Contact information
Practice address
123 REVERE ST, REVERE, MA 02151-4439
(617) 275-6306
Mailing address
8 BRIGHTON ST APT 3, CHARLESTOWN, MA 02129-1260
(617) 275-6306
(617) 997-0030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
12/29/2023
Last updated
12/29/2023
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