Organization
IVORY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSHMA REDDY DONTHI REDDY D.M.D (PRESIDENT)
(908) 955-3699
Entity
Organization
Contact information
Practice address
176 MAIN ST, UNIT #210, SOUTHBRIDGE, MA 01550-2561
(908) 955-3699
Mailing address
176 MAIN ST, UNIT #210, SOUTHBRIDGE, MA 01550-2561
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1855451
MA
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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