Organization
SOUTHBRIDGE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUMAN REDDIVARI DMD (MEMBER)
(781) 552-1567
Entity
Organization
Contact information
Practice address
305 MAIN ST, SOUTHBRIDGE, MA 01550-3726
(508) 765-0880
Mailing address
305 MAIN ST, SOUTHBRIDGE, MA 01550-3726
(508) 765-0880
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3071228
—
NH
Enumeration date
06/18/2019
Last updated
09/20/2021
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