Provider Demographics
NPI:1003282369
Name:BRIDGESMILESDENTAL
Entity Type:Organization
Organization Name:BRIDGESMILESDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENNADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:417-693-2660
Mailing Address - Street 1:15 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2110
Mailing Address - Country:US
Mailing Address - Phone:908-725-0400
Mailing Address - Fax:
Practice Address - Street 1:15 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2110
Practice Address - Country:US
Practice Address - Phone:908-725-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02614400261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental