Organization
NEDG BOSTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GOKULAN THIAGARAJAH DO (DIRECTOR OF OPERATIONS)
(508) 962-2332
Entity
Organization
Contact information
Practice address
1 MILK ST, BOSTON, MA 02109-5413
(508) 281-6464
(508) 281-6677
Mailing address
257 TURNPIKE RD STE 330, SOUTHBOROUGH, MA 01772-1791
(508) 281-6464
(508) 281-6677
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801936075
DELTA DENTAL OF MA
MA
Enumeration date
06/16/2020
Last updated
06/16/2020
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