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General NPI Number Information
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NPI Number | 1285577460
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Entity Type | Organization
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Legal Business Name | STURBRIDGE DENTAL PLLC
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 57 MAIN ST STE 2
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City | STURBRIDGE
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State | MA
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Zip | 01566-1283
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Country | US
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Telephone | 740-215-8549
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BALANCING ROCK RD ENTER ADDRESS LINE 2
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City | CANTON
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State | MA
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Zip | 02021-4230
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Country | US
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Telephone | 740-215-8549
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SRINIVAS DESANEEDI
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Credential | DMD
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Telephone | 740-215-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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