Provider Demographics
NPI:1386139970
Name:SWEET SMILES MT. PLEASANT LLC
Entity type:Organization
Organization Name:SWEET SMILES MT. PLEASANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RADHA KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-672-2393
Mailing Address - Street 1:3113 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4409
Practice Address - Country:US
Practice Address - Phone:262-672-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty