Provider Demographics
NPI:1942581384
Name:BHANDARU, SIRISHA (DMD)
Entity type:Individual
Prefix:
First Name:SIRISHA
Middle Name:
Last Name:BHANDARU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1233
Mailing Address - Country:US
Mailing Address - Phone:972-245-3455
Mailing Address - Fax:972-242-1686
Practice Address - Street 1:4116 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1233
Practice Address - Country:US
Practice Address - Phone:972-245-3455
Practice Address - Fax:972-242-1686
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25588122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist