Provider Demographics
NPI:1164256251
Name:FIRST COMMONWEALTH DENTAL LLC
Entity type:Organization
Organization Name:FIRST COMMONWEALTH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YADAV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:573-639-0497
Mailing Address - Street 1:11 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-3707
Practice Address - Country:US
Practice Address - Phone:508-909-6122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST COMMONWEALTH DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental