My Dental Southbridge PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MY DENTAL SOUTHBRIDGE PLLC

Practice address

305 Main St
Southbridge, MA 01550-3726

Phone

(508) 765-0880

NPI assigned

Aug 30, 2023

Organization subpart

No

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

Authorized official

Name

Srinivas Desaneedi, DMD

Title

Owner

Phone

(740) 215-8549

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1316722069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BALANCING ROCK RD",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214230",
            "telephone_number": "740-215-8549",
            "fax_number": "508-300-1275"
        },
        {
            "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": "MY DENTAL SOUTHBRIDGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "DESANEEDI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-215-8549",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Moreau, RD, LDN
• Donna Frances Morrison, M.ED.
• Lindsey Lee Murphy, RN
• Jennifer Lynne Murray, LICSW
• Anthony Ngugi Mwangi
• Amanda Tatlock Nascimento, MS, LCGC
• Joseph Natale
• Natalie M. Stanley, DMD & Associates, PC
• Patricia Christine Nellis
• Sarah Nelson, BACHELOR OF SCIENCE

• Dental Clinic/Center in Southbridge, MA
• Providers in Southbridge, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.