Southbridge Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTHBRIDGE DENTAL LLC

Practice address

305 Main St
Southbridge, MA 01550-3726

Phone

(508) 765-0880

NPI assigned

Jun 18, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Suman Reddivari, DMDNPI 1033347588

Title

Member

Phone

(781) 552-1567

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suman Reddivari, D.M.D

  • General Practice Dentistry
  • Concord, NH
  • NPI 1033347588
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1184284549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 MAIN ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015503726",
            "telephone_number": "508-765-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 MAIN ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015503726",
            "telephone_number": "508-765-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBRIDGE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-18",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "REDDIVARI",
        "authorized_official_first_name": "SUMAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "781-552-1567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3071228",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles A Sommer, MD
• Shaukat Soofi, APRN
• Adrienne Ellen Soucy
• South County Therapies LLC
• Southbridge Braces PC
• Southbridge Ma SNF LLC
• Southbridge OB GYN Assoc
• Southbridge Public School
• Southbridge Public Schools
• Southbridge SNF Operations, LLC

• General Practice Dentistry in Southbridge, MA
• Providers in Southbridge, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.