Provider Demographics
NPI:1922451202
Name:SHRINATH LLC
Entity Type:Organization
Organization Name:SHRINATH LLC
Other - Org Name:HEALTHY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:UTSAV
Authorized Official - Middle Name:DIPAKKUMAR
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-784-5293
Mailing Address - Street 1:368 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2506
Mailing Address - Country:US
Mailing Address - Phone:617-784-5293
Mailing Address - Fax:
Practice Address - Street 1:368 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2506
Practice Address - Country:US
Practice Address - Phone:617-784-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT111671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty