Provider Demographics
NPI:1316226624
Name:OCEANSIDE FAMILY DENTAL
Entity Type:Organization
Organization Name:OCEANSIDE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEELIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-926-1551
Mailing Address - Street 1:750 LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842
Mailing Address - Country:US
Mailing Address - Phone:603-926-1551
Mailing Address - Fax:603-926-1563
Practice Address - Street 1:750 LAFAYETTE ROAD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842
Practice Address - Country:US
Practice Address - Phone:603-926-1551
Practice Address - Fax:603-926-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty