Individual
VIJITHA SANAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
274 WALNUT ST, UNIT-1, SHREWSBURY, MA 01545-3318
(508) 925-5562
Mailing address
274 WALNUT ST, UNIT-1, SHREWSBURY, MA 01545-3318
(508) 925-5562
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22154
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22154
DENTAL LICENSE
MA
Enumeration date
07/27/2008
Last updated
03/30/2022
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