Provider Demographics
NPI:1649518069
Name:RADIANCE ENDODONTICS LLC
Entity type:Organization
Organization Name:RADIANCE ENDODONTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAHASA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-484-8740
Mailing Address - Street 1:730 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3524
Mailing Address - Country:US
Mailing Address - Phone:941-484-8740
Mailing Address - Fax:
Practice Address - Street 1:730 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3524
Practice Address - Country:US
Practice Address - Phone:941-484-8740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty