Provider Demographics
NPI:1851135875
Name:ESTHETIC DENTAL IMPLANTS STUDIO LLC
Entity type:Organization
Organization Name:ESTHETIC DENTAL IMPLANTS STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:SIVA REDDY
Authorized Official - Last Name:GUVVA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:419-819-7450
Mailing Address - Street 1:19301 E US HIGHWAY 40 STE A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5572
Mailing Address - Country:US
Mailing Address - Phone:816-886-5899
Mailing Address - Fax:816-873-1938
Practice Address - Street 1:19301 E US HIGHWAY 40 STE A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5572
Practice Address - Country:US
Practice Address - Phone:816-886-5899
Practice Address - Fax:816-873-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty