Provider Demographics
NPI:1275386211
Name:SAI RAGHAVENDRA DENTAL GROUP PC
Entity Type:Organization
Organization Name:SAI RAGHAVENDRA DENTAL GROUP PC
Other - Org Name:SMILES OF FRISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHIPULUSU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-598-1042
Mailing Address - Street 1:400 STONEBROOK PKWY UNIT 401
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-1181
Mailing Address - Country:US
Mailing Address - Phone:469-598-1042
Mailing Address - Fax:
Practice Address - Street 1:400 STONEBROOK PKWY UNIT 401
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-1181
Practice Address - Country:US
Practice Address - Phone:469-598-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental