| Park Avenue Dental Center | |
|
431b Park Ave Worcester MA 01610-1335 | |
| (508) 799-4555 | |
| (508) 770-1990 |
| Full Name | Park Avenue Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 431b Park Ave, Worcester, Massachusetts |
| Authorized Official Name and Position | Gokulan Thiagarajah (PRESIDENT) |
| Authorized Official Contact | 5084851114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Avenue Dental Center 431b Park Ave Worcester MA 01610-1335 Ph: (508) 799-4555 | Park Avenue Dental Center 431b Park Ave Worcester MA 01610-1335 Ph: (508) 799-4555 |
| NPI Number | 1316091184 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 06/29/2022 |
| Medicare PECOS PAC ID | 1254695588 |
|---|---|
| Medicare Enrollment ID | O20180514000676 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316091184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18683 (Massachusetts) | Primary |
| Provider Name | Iham Gammas |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1861689309 PECOS PAC ID: 8628399185 Enrollment ID: I20180514001329 |
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