Organization
MY DENTAL REVERE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVAS DESANEEDI DMD (OWNER)
(740) 215-8549
Entity
Organization
Contact information
Practice address
1401 ROCK WOOD DR, SAUGUS, MA 01906-4537
(740) 215-8549
Mailing address
1401 ROCK WOOD DR, SAUGUS, MA 01906-4537
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN22184
MA
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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