Provider Demographics
NPI:1043316904
Name:NALLURI, SARAT (DDS)
Entity Type:Individual
Prefix:
First Name:SARAT
Middle Name:
Last Name:NALLURI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7067 TIFFANY BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1958
Mailing Address - Country:US
Mailing Address - Phone:330-629-9021
Mailing Address - Fax:330-965-9237
Practice Address - Street 1:7067 TIFFANY BLVD STE 260
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1958
Practice Address - Country:US
Practice Address - Phone:330-629-9021
Practice Address - Fax:330-965-9237
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300209011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2109668Medicaid