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General NPI Number Information
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NPI Number | 1649518069
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Entity Type | Organization
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Legal Business Name | RADIANCE ENDODONTICS LLC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 730 THE RIALTO
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City | VENICE
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State | FL
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Zip | 34285-3524
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Country | US
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Telephone | 941-484-8740
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Fax |
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Provider Business Mailing Address
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Address Line | 730 THE RIALTO
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City | VENICE
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State | FL
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Zip | 34285-3524
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Country | US
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Telephone | 941-484-8740
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SHEILA CHANDRAHASA
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Credential | DMD
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Telephone | 941-484-8740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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