Provider Demographics
NPI:1235417767
Name:ABBARAJU, SRAVAN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:SRAVAN
Middle Name:K
Last Name:ABBARAJU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BANDERA CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3291
Mailing Address - Country:US
Mailing Address - Phone:832-920-1324
Mailing Address - Fax:
Practice Address - Street 1:211 W EL DORADO BLVD STE C
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-6533
Practice Address - Country:US
Practice Address - Phone:832-895-3405
Practice Address - Fax:832-895-3405
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272391223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry