| Ivory Dental Pc | |
|
176 Main St Unit #210 Southbridge MA 01550-2561 | |
| (908) 955-3699 | |
| Not Available |
| Full Name | Ivory Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 176 Main St, Southbridge, Massachusetts |
| Authorized Official Name and Position | Sushma Reddy Donthi Reddy (PRESIDENT) |
| Authorized Official Contact | 9089553699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivory Dental Pc 176 Main St Unit #210 Southbridge MA 01550-2561 Ph: () - | Ivory Dental Pc 176 Main St Unit #210 Southbridge MA 01550-2561 Ph: (908) 955-3699 |
| NPI Number | 1770902090 |
|---|---|
| Provider Enumeration Date | 04/15/2014 |
| Last Update Date | 04/15/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770902090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN1855451 (Massachusetts) | Primary |
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