Individual
SUJATHA L REVUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GENERAL DENTISTRY
Contact information
Practice address
26 QUEEN ST, DENTAL, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7990
Mailing address
26 QUEEN ST, DENTAL, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7990
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19824
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300709
—
MA
01
—
19824
ALTUS DENTAL
MA
01
—
41770
HARVARD PILGRIM
MA
01
—
Y10141
BCBS DENTAL-GROUP
MA
Enumeration date
08/11/2006
Last updated
07/09/2007
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