Organization
SUNNY SMILES FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRICHARAN MAHAVADI DDS (DENTIST)
(304) 258-2291
Entity
Organization
Contact information
Practice address
345 CONCORD AVE, BERKELEY SPRINGS, WV 25411-1235
(304) 258-2291
Mailing address
345 CONCORD AVE, BERKELEY SPRINGS, WV 25411-1235
(304) 258-2291
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WV4339
WV DENTAL BOARD
WV
Enumeration date
12/09/2020
Last updated
12/09/2020
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