Provider Demographics
NPI:1114162930
Name:SARIDE VENKATA, PRIYADARSHINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYADARSHINI
Middle Name:
Last Name:SARIDE VENKATA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 S PRIEST DR APT 2142
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1087
Mailing Address - Country:US
Mailing Address - Phone:682-386-2332
Mailing Address - Fax:
Practice Address - Street 1:530 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1549
Practice Address - Country:US
Practice Address - Phone:682-386-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056607-1122300000X
CT009954122300000X
AZ10904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist