Provider Demographics
NPI:1447944012
Name:SUDBURY ENDODONTICS LLC
Entity type:Organization
Organization Name:SUDBURY ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKKHOLGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-717-4316
Mailing Address - Street 1:111 BOSTON POST RD STE 215
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2457
Mailing Address - Country:US
Mailing Address - Phone:978-579-4403
Mailing Address - Fax:
Practice Address - Street 1:111 BOSTON POST RD STE 215
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2457
Practice Address - Country:US
Practice Address - Phone:978-579-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty