My Dental LLC
Organization Active NPI Dental Clinic/Center · Waltham, MA
NPI 1366722100 · NPPES record last updated Aug 24, 2011
Key facts
- NPI
- 1366722100
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- License
- 22184 (MA)
- Legal business name
- MY DENTAL LLC
- Practice address
- 314 Moody St
Suite B
Waltham, MA 02453-5202 - Phone
- (740) 215-8549
- NPI assigned
- Aug 24, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Srinivas Desaneedi, DMD
- Title
- Dentist
- Phone
- (740) 215-8549
National Provider Directory
Locations
314 Moody St
#B
Waltham, MA 02453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 22184 | MA | Yes |
Addresses
Primary practice location
314 Moody St
Suite B
Waltham, MA 02453-5202
Mailing address
184 Kennedy Dr
Apt 10
Malden, MA 02148-3402
Phone (740) 215-8549
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- Poornima Mysore Vishwanath
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All providers in Waltham, MA · Dental Clinic/Center in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.