Individual
PALAK BOTHRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
635 ALBANY ST, BOSTON, MA 02118-3550
(952) 855-2188
Mailing address
1410 COLUMBIA RD APT 1G, SOUTH BOSTON, MA 02127-4014
(952) 855-2188
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DL100422
MA
390200000X
Student in an Organized Health Care Education/Training Program
DL100422
MA
Other
Enumeration date
06/18/2025
Last updated
06/18/2025
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