My Dental LLC
NPI #1366722100 in Waltham, Massachusetts
Provider Information
- NPI Number
- 1366722100
- Entity Type
- Organization
- Organization Name
- My Dental LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Aug 24, 2011
- Last Updated
- Aug 24, 2011
Practice Location
- Address
- 314 MOODY ST
- Address 2
- SUITE B
- City
- Waltham
- State
- Massachusetts
- ZIP Code
- 02453-5202
- Phone
- (740) 215-8549
Authorized Official
- Name
- DR. SRINIVAS DESANEEDI, DMD
- Title
- DENTIST
- Phone
- (740) 215-8549
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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