Provider Demographics
NPI:1467782730
Name:RADIANT SMILES DENTAL INC
Entity Type:Organization
Organization Name:RADIANT SMILES DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-609-4867
Mailing Address - Street 1:1305 KNOX ABBOTT DR
Mailing Address - Street 2:STE-101
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3348
Mailing Address - Country:US
Mailing Address - Phone:773-609-4867
Mailing Address - Fax:803-832-0799
Practice Address - Street 1:1305 KNOX ABBOTT DR
Practice Address - Street 2:STE-101
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3348
Practice Address - Country:US
Practice Address - Phone:773-609-4867
Practice Address - Fax:803-832-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty