Provider Demographics
NPI:1720642143
Name:AKRADI DENTAL, LLC
Entity type:Organization
Organization Name:AKRADI DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:651-278-1902
Mailing Address - Street 1:616 E 4TH ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3331
Mailing Address - Country:US
Mailing Address - Phone:651-278-1902
Mailing Address - Fax:
Practice Address - Street 1:21 BAY STATE RD # 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2101
Practice Address - Country:US
Practice Address - Phone:617-247-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental