Provider Demographics
NPI:1972273092
Name:OS DENTAL LLC
Entity Type:Organization
Organization Name:OS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ MANAGER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDIVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-552-1567
Mailing Address - Street 1:9 EASY ST
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1579
Mailing Address - Country:US
Mailing Address - Phone:781-552-1567
Mailing Address - Fax:
Practice Address - Street 1:155 DOW ST STE 401
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-3200
Practice Address - Country:US
Practice Address - Phone:603-622-6073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty