| NPI | 1922832880 |
|---|---|
| Doing Business As | SOUTH MAIN DENTAL |
| Entity Type | Organization |
| Authorized Contact | TARAKESWAR REDDY VONGURU President 617-816-1759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-08-31 |
| Last Update Date | 2024-08-31 |