Provider Demographics
NPI:1467239608
Name:MOTURU, SRI HARSHITA (DMD)
Entity Type:Individual
Prefix:
First Name:SRI
Middle Name:HARSHITA
Last Name:MOTURU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 GAGE AVE APT 281
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1593
Mailing Address - Country:US
Mailing Address - Phone:781-308-8698
Mailing Address - Fax:
Practice Address - Street 1:639 ALTA MERE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-4019
Practice Address - Country:US
Practice Address - Phone:817-717-1508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399991223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice