1555 St Management Group, Inc.

NPI #1326295163 in Tewksbury, Massachusetts

Provider Information

NPI Number: 1326295163
Entity Type: Organization
Organization Name: 1555 St Management Group, Inc.
Primary Specialty: Dentist
Enumeration Date: Aug 22, 2008
Last Updated: Aug 22, 2008

Practice Location

Address: 1555 MAIN ST
Address 2: SUITE 203
City: Tewksbury
State: Massachusetts
ZIP Code: 01876-4741
Phone: (978) 851-5300

Authorized Official

Name: MR. SANJAYAN THIAGARAJAH
Title: PRESIDENT
Phone: (978) 851-5300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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