Provider Demographics
NPI:1215584545
Name:VIRDI DENTAL
Entity Type:Organization
Organization Name:VIRDI DENTAL
Other - Org Name:SWEET LIME LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-764-7631
Mailing Address - Street 1:2634 CAREY AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1918
Mailing Address - Country:US
Mailing Address - Phone:309-269-7662
Mailing Address - Fax:
Practice Address - Street 1:850 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7169
Practice Address - Country:US
Practice Address - Phone:309-764-7631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental