| Southbridge Dental Llc | |
|
305 Main St Southbridge MA 01550-3726 | |
| (508) 765-0880 | |
| Not Available |
| Full Name | Southbridge Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 305 Main St, Southbridge, Massachusetts |
| Authorized Official Name and Position | Suman Reddivari (MEMBER) |
| Authorized Official Contact | 7815521567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southbridge Dental Llc 305 Main St Southbridge MA 01550-3726 Ph: (508) 765-0880 | Southbridge Dental Llc 305 Main St Southbridge MA 01550-3726 Ph: (508) 765-0880 |
| NPI Number | 1184284549 |
|---|---|
| Provider Enumeration Date | 06/18/2019 |
| Last Update Date | 09/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184284549 | NPI | - | NPPES |
| 3071228 | Medicaid | NH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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