Provider Demographics
NPI:1346658762
Name:SHOBHA DENTAL CARE, PA
Entity Type:Organization
Organization Name:SHOBHA DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-332-0530
Mailing Address - Street 1:6260 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9148
Mailing Address - Country:US
Mailing Address - Phone:864-332-0530
Mailing Address - Fax:
Practice Address - Street 1:6260 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-9148
Practice Address - Country:US
Practice Address - Phone:864-332-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty