Provider Demographics
NPI:1518363118
Name:BHAVANA AGADI DMD LLC
Entity Type:Organization
Organization Name:BHAVANA AGADI DMD LLC
Other - Org Name:DENTAL SMILES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-694-2371
Mailing Address - Street 1:147 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4817
Mailing Address - Country:US
Mailing Address - Phone:617-694-2371
Mailing Address - Fax:
Practice Address - Street 1:1241 MAIN ST UNIT 8
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1842
Practice Address - Country:US
Practice Address - Phone:508-757-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty