Provider Demographics
NPI:1366706681
Name:SRINIVASAN, SREEDEVI (BDS, DSC,)
Entity type:Individual
Prefix:
First Name:SREEDEVI
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:BDS, DSC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DENTAL SCIENCE S
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1001
Mailing Address - Country:US
Mailing Address - Phone:319-384-1139
Mailing Address - Fax:319-384-1785
Practice Address - Street 1:322 DENTAL SCIENCE S
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1001
Practice Address - Country:US
Practice Address - Phone:319-384-1139
Practice Address - Fax:319-384-1785
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA401381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics