Provider Demographics
NPI:1871528877
Name:SNELL, GAYATHRI (DDS)
Entity type:Individual
Prefix:DR
First Name:GAYATHRI
Middle Name:
Last Name:SNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GAYATHRI
Other - Middle Name:
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:363 GREAT RD
Mailing Address - Street 2:#205
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2800
Mailing Address - Country:US
Mailing Address - Phone:781-275-2157
Mailing Address - Fax:781-275-2158
Practice Address - Street 1:363 GREAT RD
Practice Address - Street 2:#205
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2800
Practice Address - Country:US
Practice Address - Phone:781-275-2157
Practice Address - Fax:781-275-2158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9763660Medicaid