Pravin Chellamuthu, D.M.D
Individual provider Active NPI Dentist · Raynham, MA
NPI 1295923654 · NPPES record last updated Oct 11, 2007
Key facts
- NPI
- 1295923654
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22008 (MA)
- Practice address
- 500 South St W
Raynham, MA 02767-5342 - Phone
- (508) 821-1428
- NPI assigned
- Oct 11, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22008 | MA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22008 | MA | Yes |
Addresses
Primary practice location
500 South St W
Raynham, MA 02767-5342
Mailing address
35 Northampton St
Apt # 2105
Boston, MA 02118-4014
Phone (857) 753-7213
Other providers in Raynham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.