Individual
PRADEEP KUMAR BHOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
465 S BROADWAY, LAWRENCE, MA 01843-3526
(802) 476-3171
Mailing address
125 PLEASANT ST APT 401, BROOKLINE, MA 02446-7180
(425) 624-8172
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1858841
MA
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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