Individual provider · Type 1 NPI
Prashansa Gautam
Dental Clinic/Center · Boston, MA
NPI number
1700636651
Active
Practice location
50 S Huntington Ave
Boston, MA 02130-4713
Mailing address
22 College Dr
Stony Brook, NY 11790-2724
Other practice locations
- 22 College Dr, Stony Brook, NY 11790-2724 · (631) 624-5914
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dental Clinic/Center Primary | 261QD0000X | None listed |
Dental Clinic/Center: Definition to come...
Other dental clinic/center providers in Boston
About NPI 1700636651
Prashansa Gautam's National Provider Identifier is 1700636651, issued on Mar 25, 2024. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Boston, MA. The record was last updated on Mar 25, 2024.