Provider Demographics
NPI:1376278424
Name:DENTIST IN BOWIE LLC
Entity Type:Organization
Organization Name:DENTIST IN BOWIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-233-6141
Mailing Address - Street 1:14999 HEALTH CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14999 HEALTH CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1079
Practice Address - Country:US
Practice Address - Phone:803-233-6141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty