Provider Demographics
NPI:1740037530
Name:DENTIST IN POWELL LLC
Entity type:Organization
Organization Name:DENTIST IN POWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-830-6881
Mailing Address - Street 1:1305 KNOX ABBOTT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3348
Mailing Address - Country:US
Mailing Address - Phone:803-233-6141
Mailing Address - Fax:
Practice Address - Street 1:4091 POWELL RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7372
Practice Address - Country:US
Practice Address - Phone:803-830-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty