Provider Demographics
NPI:1184221616
Name:AMERICAN DENTAL PLLC
Entity Type:Organization
Organization Name:AMERICAN DENTAL PLLC
Other - Org Name:TODAYS DENTAL @ ALEXANDRIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-233-6141
Mailing Address - Street 1:1305 KNOX ABBOTT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3348
Mailing Address - Country:US
Mailing Address - Phone:032-336-1418
Mailing Address - Fax:
Practice Address - Street 1:4601 PINECREST OFFICE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1442
Practice Address - Country:US
Practice Address - Phone:703-256-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty