Provider Demographics
NPI:1427563568
Name:SESHADRI, SAVITHA
Entity Type:Individual
Prefix:
First Name:SAVITHA
Middle Name:
Last Name:SESHADRI
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 1:681 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5033
Mailing Address - Country:US
Mailing Address - Phone:408-842-0418
Mailing Address - Fax:408-842-0499
Practice Address - Street 1:681 1ST ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5033
Practice Address - Country:US
Practice Address - Phone:408-842-0418
Practice Address - Fax:408-842-0499
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist