Provider Demographics
NPI:1235442914
Name:SAGILI, SRIDHAR REDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:REDDY
Last Name:SAGILI
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 1:362 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-5051
Mailing Address - Country:US
Mailing Address - Phone:225-329-3095
Mailing Address - Fax:
Practice Address - Street 1:1500 SOUTHEAST 17TH STREET, BLDG 400
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5051
Practice Address - Country:US
Practice Address - Phone:352-502-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19674122300000X
TX00258291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist