Organization
SSVA1411 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHOBA VISWANATHAN DDS (DENTIST)
(415) 335-5537
Entity
Organization
Contact information
Practice address
894 SIM HODGIN PKWY, RICHMOND, IN 47374-1931
(317) 526-0309
Mailing address
12576 BELLINGHAM BLVD, FISHERS, IN 46037-4207
(415) 335-3537
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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