Provider Demographics
NPI:1548655541
Name:VIRTUDENT MA LLC
Entity type:Organization
Organization Name:VIRTUDENT MA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HITESH
Authorized Official - Middle Name:GULAB
Authorized Official - Last Name:TOLANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-863-4569
Mailing Address - Street 1:21 DRYDOCK AVE
Mailing Address - Street 2:STE 610
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2384
Mailing Address - Country:US
Mailing Address - Phone:617-863-4569
Mailing Address - Fax:
Practice Address - Street 1:21 DRYDOCK AVE. 6TH FLOOR
Practice Address - Street 2:C/O MASSCHALLENGE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210
Practice Address - Country:US
Practice Address - Phone:617-863-4569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No125J00000XDental ProvidersDental TherapistGroup - Multi-Specialty
No125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty