Organization
BEST SMILE DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVEEN KUMAR GAJENDRAREDDY DDS (MEMBER/ MANAGER)
(614) 657-8312
Entity
Organization
Contact information
Practice address
490 W LAKE ST, 107, ROSELLE, IL 60172-3583
(614) 657-8312
Mailing address
1841 MAINE DR, ELK GROVE VILLAGE, IL 60007-2728
(614) 657-8312
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
021.002403
IL
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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