Provider Demographics
NPI:1871732123
Name:DENTAL QUEST INC
Entity type:Organization
Organization Name:DENTAL QUEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAMATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-458-3456
Mailing Address - Street 1:1275 PAWTUCKET BLVD
Mailing Address - Street 2:SUIT#1
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1070
Mailing Address - Country:US
Mailing Address - Phone:978-458-3456
Mailing Address - Fax:978-923-7906
Practice Address - Street 1:1275 PAWTUCKET BLVD
Practice Address - Street 2:SUIT#1
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1070
Practice Address - Country:US
Practice Address - Phone:978-458-3456
Practice Address - Fax:978-923-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty