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General NPI Number Information
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NPI Number | 1093119497
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Entity Type | Organization
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Legal Business Name | SOUHEGAN VALLEY DENTAL
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 99 AMHERST ST
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City | MILFORD
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State | NH
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Zip | 03055-4017
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Country | US
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Telephone | 603-673-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 99 AMHERST ST
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City | MILFORD
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State | NH
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Zip | 03055-4017
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Country | US
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Telephone | 603-673-1233
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SREEMALI VASANTHA I
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Credential | DMD
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Telephone | 857-544-0609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3444
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License Number State | NH
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