Provider Demographics
NPI:1407604192
Name:RM DENTAL SERVICES LLC
Entity type:Organization
Organization Name:RM DENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHUKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-355-5000
Mailing Address - Street 1:607 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9001
Mailing Address - Country:US
Mailing Address - Phone:440-355-5000
Mailing Address - Fax:
Practice Address - Street 1:607 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9001
Practice Address - Country:US
Practice Address - Phone:440-355-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty