Provider Demographics
NPI:1952865933
Name:NUSMILE DENTAL LLC
Entity Type:Organization
Organization Name:NUSMILE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEETHRAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-666-7415
Mailing Address - Street 1:10107 VERREE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3613
Mailing Address - Country:US
Mailing Address - Phone:267-388-7754
Mailing Address - Fax:
Practice Address - Street 1:10107 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3613
Practice Address - Country:US
Practice Address - Phone:267-388-7754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS039249OtherSTATE LICENSE