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SOUTHBRIDGE DENTAL LLC NPI 1184284549


NPI Information

NPI: 1184284549
Provider Name: SOUTHBRIDGE DENTAL LLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
305 MAIN ST
SOUTHBRIDGE, MA
ZIP 01550
Phone: (508) 765-0880
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SOUTHBRIDGE DENTAL LLC is a general practice dentist in Southbridge, MA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. SOUTHBRIDGE DENTAL LLC NPI is 1184284549. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

305 MAIN ST
SOUTHBRIDGE, MA
ZIP 01550-726
Phone: (508) 765-0880

The provider's authorized official is Suman Reddivari .
The authorized official title is Member and has the following contact phone number (781) 552-1567.

The enumeration date for this NPI number is 6/18/2019 and was last updated on 9/20/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13071228MEDICAIDNEW HAMPSHIRE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.