Organization
STELLAR SMILES FAMILY DENTAL LLC
Active
Other names
Hathorne Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEERTHY REDDY CHILAKAMARRY DMD (OWNER)
(781) 606-2148
Entity
Organization
Contact information
Practice address
491 MAPLE ST STE 302, DANVERS, MA 01923-4026
(703) 953-4088
Mailing address
491 MAPLE ST STE 302, DANVERS, MA 01923-4026
(703) 953-4088
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN1857756
LICENSE NUMBER
MA
Enumeration date
03/05/2024
Last updated
03/05/2024
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