Provider Demographics
NPI:1043073208
Name:KRISHNADAS, SRI MOOKAMBIKA (BDS)
Entity Type:Individual
Prefix:DR
First Name:SRI MOOKAMBIKA
Middle Name:
Last Name:KRISHNADAS
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 QUARRY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1026
Mailing Address - Country:US
Mailing Address - Phone:508-679-8111
Mailing Address - Fax:
Practice Address - Street 1:387 QUARRY ST STE 100
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1026
Practice Address - Country:US
Practice Address - Phone:508-679-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL16013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist