Organization
SMILE LINE PC
Active
Other names
RIVERDALE DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY GADDAM DMD (OWNER)
(419) 450-2211
Entity
Organization
Contact information
Practice address
1073 RIVERDALE ST, WEST SPRINGFIELD, MA 01089-4614
(413) 285-7114
Mailing address
20 PINEWOOD DR, LONGMEADOW, MA 01106-1638
(419) 450-2211
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9211482
—
MA
Enumeration date
07/07/2017
Last updated
08/01/2017
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