Provider Demographics
NPI:1174817753
Name:SOWJANYA SRIKANTAM DDS INC
Entity type:Organization
Organization Name:SOWJANYA SRIKANTAM DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SOWJANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIKANTAM
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:510-790-1814
Mailing Address - Street 1:2324 SANTA RITA RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4152
Mailing Address - Country:US
Mailing Address - Phone:925-249-1130
Mailing Address - Fax:
Practice Address - Street 1:2324 SANTA RITA RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4152
Practice Address - Country:US
Practice Address - Phone:925-249-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty