# SSVA1411 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922664267
- **Authorized official:** DR. SHOBA VISWANATHAN DDS (DENTIST)
- **Authorized official phone:** (415) 335-5537

## Contact information

- **Practice address:** 894 SIM HODGIN PKWY, RICHMOND, IN 47374-1931
- **Practice address phone:** (317) 526-0309
- **Mailing address:** 12576 BELLINGHAM BLVD, FISHERS, IN 46037-4207
- **Mailing address phone:** (415) 335-3537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2019
- **Last updated:** 05/13/2019