Organization
MY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVAS DESANEEDI DMD (DENTIST)
(740) 215-8549
Entity
Organization
Contact information
Practice address
314 MOODY ST, SUITE B, WALTHAM, MA 02453-5202
(740) 215-8549
Mailing address
184 KENNEDY DR, APT 10, MALDEN, MA 02148-3402
(740) 215-8549
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22184
MA
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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