Provider Demographics
NPI:1114190303
Name:DONTHIREDDY, SIRISHA
Entity Type:Individual
Prefix:
First Name:SIRISHA
Middle Name:
Last Name:DONTHIREDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WISTERIA CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3882
Mailing Address - Country:US
Mailing Address - Phone:631-948-5036
Mailing Address - Fax:
Practice Address - Street 1:1745 UNION BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7952
Practice Address - Country:US
Practice Address - Phone:631-968-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist