SMILE LINE PC (NPI# 1457873895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457873895 |
| Entity Type | Organization |
| Organization Name | SMILE LINE PC |
| Other Organization Name | RIVERDALE DENTAL |
| Practice Address |
1073 Riverdale St West Springfield MA 01089-4614 |
| Mailing Address |
20 Pinewood Dr Longmeadow MA 01106-1638 |
| Practice Telephone | 4132857114 |
| Mailing Telephone | 4194502211 |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2017-08-01 |
| Authorized Official Name | DR. VIJAY GADDAM (OWNER) |
| Authorized Official Telephone | 4194502211 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 9211482 | 05 |
| Other Name | Type Code |
|---|---|
| RIVERDALE DENTAL | Doing Business As Name - Organization |
| Street Address |
1073 RIVERDALE ST |
| City | WEST SPRINGFIELD |
| State | MA |
| Zip Code | 01089-4614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821250820 | Vijay Bhaskar Reddy Gaddam | Dentist | 1073 Riverdale St, West Springfield, MA 01089-4614 | 2008-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366040990 | Konrad Syrek | Behavioral Analyst | 1472 Riverdale St. Suite A, West Springfield, MA 01089 | 2020-10-15 |
| 1861099335 | Vanna Leang | Behavioral Analyst | 1472 Riverdale St, Suite A, West Springfield, MA 01089 | 2020-10-07 |
| 1215534755 | Malakie Berry | Behavioral Analyst | 1472 Riverdale St., Suite A, West Springfield, MA 01089 | 2020-10-07 |
| 1952800930 | Nicole Coughlin | Social Worker | 103 Myron St. Suite A, West Springfield, MA 01089 | 2018-02-06 |
| 1679017156 | Tender Care Helping Hands LLC | Home Health | 1434 Memorial Ave, Westspringfield, MA 01089 | 2016-12-19 |
| 1154736130 | Mikin Patel | Dentist | 235b Memorial Ave, West Springfield, MA 01089 | 2014-06-27 |
| 1881029312 | Melinda A Koblosh | Physical Therapist | 1111 Elm St., Suite 9, West Springfield, MA 01089 | 2013-09-03 |
| 1316379852 | Jessica C Marquez | Social Worker | 204 Wayside Ave, West Springfield, MA 01089 | 2013-08-07 |
| 1114360112 | Center for Human Development | In Home Supportive Care | 247 Park St, West Springfield, MA 01089 | 2013-04-10 |
| 1336421395 | John L. O'neill | Social Worker | 103 Myron Street Suite A, West Springfield, MA 01089 | 2011-09-15 |
| Find all providers in zip 01089 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659889855 | Cole G. Archambault Dmd, Pllc | Clinic/Center | 1284 Elm St Ste 1, West Springfield, MA 01089-1847 | 2018-01-22 |
| 1508206012 | Trustees of Tufts University | Clinic/Center | 1275 Elm St, West Springfield, MA 01089-1820 | 2013-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265771 | Sidhu Family Dental LLC | Clinic/Center | 15 West St Ste 101, Douglas, MA 01516-2160 | 2020-11-04 |
| 1205436276 | The Nurture Frenectomy Center | Clinic/Center | 200 Elm St Ste 1, Pittsfield, MA 01201-6551 | 2020-10-29 |
| 1417557463 | Marva Khalid Dentistry PC | Clinic/Center | 105 Chestnut St Ste 25, Needham, MA 02492-2520 | 2020-10-29 |
| 1417555855 | Gardner Smiles Pllc | Clinic/Center | 356 Timpany Blvd, Gardner, MA 01440-5200 | 2020-10-16 |
| 1326646399 | Restoration Smiles, P.C. | Clinic/Center | 2 Coolidge St Ste 202, Hudson, MA 01749-1459 | 2020-10-13 |
| 1295333573 | Brian P. Ganley, Dmd, PC | Clinic/Center | 134 Main St Unit 1c, Groton, MA 01450-1375 | 2020-10-09 |
| 1619583168 | Newton Wellesley Dental Group LLC | Clinic/Center | 447 Centre Street, Same, Newton, MA 02458 | 2020-09-21 |
| 1114533866 | Cdg Back Bay LLC | Clinic/Center | 400 Commonwealth Ave 3rd Floor, Boston, MA 02215 | 2020-09-18 |
| 1831703099 | Beacon Dental Health PC | Clinic/Center | 80 Washington St Bldg B, Norwell, MA 02061-1740 | 2020-09-04 |
| 1487267282 | Shoe City Family Dental PC | Clinic/Center | 103 Merrimack St, Haverhill, MA 01830-6208 | 2020-08-31 |
| Find all providers with the same taxonomy | ||||
| City | WEST SPRINGFIELD |
| Zip Code | 01089 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.