Provider Demographics
NPI:1457622136
Name:VSMILEDENTAL VAISHALI SUCHAK LLC
Entity Type:Organization
Organization Name:VSMILEDENTAL VAISHALI SUCHAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAUSHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-344-0170
Mailing Address - Street 1:603 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2504
Mailing Address - Country:US
Mailing Address - Phone:215-788-4200
Mailing Address - Fax:
Practice Address - Street 1:603 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2504
Practice Address - Country:US
Practice Address - Phone:215-788-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty