Provider Demographics
NPI:1114405388
Name:KONDAKINDI, SRUTHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SRUTHI
Middle Name:
Last Name:KONDAKINDI
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 1:15959 AVENIDA VENUSTO APT 1432
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5303
Mailing Address - Country:US
Mailing Address - Phone:480-297-9036
Mailing Address - Fax:
Practice Address - Street 1:31754 TEMECULA PKWY STE E
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6805
Practice Address - Country:US
Practice Address - Phone:951-694-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1027021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice