Individual
DR. SIVABALAN VASUDAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BDSC MDSC MORTHRCS
Contact information
Practice address
300 LONGWOOD AVE, HUNNEWELL-4, MAIL STOP: HU-226, BOSTON, MA 02115-5724
(617) 355-8702
(617) 730-0478
Mailing address
300 LONGWOOD AVE, HUNNEWELL-4, MAIL STOP: HU-226, BOSTON, MA 02115-5724
(617) 355-8702
(617) 730-0478
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
9734
MA
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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