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General NPI Number Information
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NPI Number | 1780474627
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Entity Type | Organization
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Legal Business Name | SHRIRAM DENTAL LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 9475 DEERECO RD STE 402
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City | TIMONIUM
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State | MD
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Zip | 21093-2124
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Country | US
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Telephone | 410-561-8845
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Fax |
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Provider Business Mailing Address
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Address Line | 3141 SONIA TRL
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-3276
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Country | US
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Telephone | 405-208-9823
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. CHARUTA MODAK
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Credential |
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Telephone | 410-561-8845
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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 |
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License Number State |
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