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General NPI Number Information
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NPI Number | 1457622136
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Entity Type | Organization
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Legal Business Name | VSMILEDENTAL VAISHALI SUCHAK LLC
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 603 VETERANS HWY
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City | BRISTOL
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State | PA
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Zip | 19007-2504
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Country | US
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Telephone | 215-788-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 603 VETERANS HWY
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City | BRISTOL
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State | PA
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Zip | 19007-2504
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Country | US
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Telephone | 215-788-4200
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KAUSHIK SUCHAK
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Credential |
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Telephone | 917-344-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS036678
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License Number State | PA
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