Provider Demographics
NPI:1316561814
Name:TAPAL, SRAVANTHI (DDS)
Entity Type:Individual
Prefix:
First Name:SRAVANTHI
Middle Name:
Last Name:TAPAL
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 1:72 BOXWOOD AVENUE
Mailing Address - Street 2:72
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 MARIANO SOUTH
Practice Address - Street 2:MARIANO BISHOP BLVD
Practice Address - City:FALLRIVER
Practice Address - State:MA
Practice Address - Zip Code:02721
Practice Address - Country:US
Practice Address - Phone:508-674-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1858660122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program