| NPI | 1114749934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDAN VENKATESH REDDY SALUKOOTI Registered Agent 732-809-6688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-10-31 |