Provider Demographics
NPI:1073715058
Name:SAI DENTAL SERVICES LLC
Entity Type:Organization
Organization Name:SAI DENTAL SERVICES LLC
Other - Org Name:BEVERLY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-927-1750
Mailing Address - Street 1:277 CABOT ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4525
Mailing Address - Country:US
Mailing Address - Phone:978-927-1750
Mailing Address - Fax:978-993-4046
Practice Address - Street 1:277 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4525
Practice Address - Country:US
Practice Address - Phone:978-927-1750
Practice Address - Fax:978-993-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-02
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12485OtherBLUE CROSS BLUE SHIELD
MA0201260Medicare ID - Type UnspecifiedMASSHEALTH