Provider Demographics
NPI:1942046818
Name:SRINIVASAN, SARATH CHANDRAN (MDS)
Entity type:Individual
Prefix:DR
First Name:SARATH
Middle Name:CHANDRAN
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 CAMERON PARC CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6454
Mailing Address - Country:US
Mailing Address - Phone:404-360-2562
Mailing Address - Fax:
Practice Address - Street 1:101 E PARK BLVD STE 475
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8818
Practice Address - Country:US
Practice Address - Phone:469-626-9858
Practice Address - Fax:469-213-5678
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics