Provider Demographics
NPI:1902402555
Name:SUNNY SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SUNNY SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SRICHARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAVADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-258-2291
Mailing Address - Street 1:345 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-1235
Mailing Address - Country:US
Mailing Address - Phone:304-258-2291
Mailing Address - Fax:
Practice Address - Street 1:345 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1235
Practice Address - Country:US
Practice Address - Phone:304-258-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV4339OtherWV DENTAL BOARD