Individual provider · NPI-1

Dr. Sanjay Reddy Bommu, D.M.D

Dentist, General Practice · Gardner, MA

NPI number1821429614
StatusActive
Last updated in NPPESDec 5, 2013

Details

NPI
1821429614
Entity type
Individual (NPI-1)
Name
Dr. Sanjay Reddy Bommu
Credential
D.M.D
Sex
Male
Sole proprietor
No
Enumeration date
Dec 5, 2013
Last updated
Dec 5, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeDN1856434MAYes

Practice location

49 Cross Street Ext
Gardner, MA 01440-2209

Phone 978-632-5659 · Fax 978-632-5713

Mailing address

49 Cross Street Ext
Gardner, MA 01440-2209

Phone 978-632-5659 · Fax 978-632-5713

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Dentist, General Practice providers in Gardner, MA