Provider Demographics
NPI:1659685352
Name:PLEASANT SMILES DENTAL LLC
Entity Type:Organization
Organization Name:PLEASANT SMILES DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SREELATHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:AVVARU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-262-5821
Mailing Address - Street 1:583 DANIEL WEBSTER HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3466
Mailing Address - Country:US
Mailing Address - Phone:603-262-5821
Mailing Address - Fax:603-262-5823
Practice Address - Street 1:583 DANIEL WEBSTER HWY
Practice Address - Street 2:SUITE D
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3466
Practice Address - Country:US
Practice Address - Phone:603-262-5821
Practice Address - Fax:603-262-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty