Provider Demographics
NPI:1790532588
Name:EDENTAL PLLC
Entity type:Organization
Organization Name:EDENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMALLAPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-703-6001
Mailing Address - Street 1:36650 GRAND RIVER AVE # 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2919
Mailing Address - Country:US
Mailing Address - Phone:248-313-8000
Mailing Address - Fax:
Practice Address - Street 1:36650 GRAND RIVER AVE # 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2919
Practice Address - Country:US
Practice Address - Phone:248-313-8000
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?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental