Organization
WHITE PARK DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SREEMALI VASANTHA DMD (SOLE MEMBER)
(603) 225-4143
Entity
Organization
Contact information
Practice address
102 PLEASANT ST, SUITE#3, CONCORD, NH 03301-3831
(603) 225-4143
Mailing address
102 PLEASANT ST, SUITE#3, CONCORD, NH 03301-3831
(603) 225-4143
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
03444
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3071214
—
NH
Enumeration date
07/24/2013
Last updated
07/24/2013
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