Provider Demographics
NPI:1477917706
Name:SAI ORAL SURGERY
Entity Type:Organization
Organization Name:SAI ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRAVANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:412-913-8877
Mailing Address - Street 1:1728 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2922
Mailing Address - Country:US
Mailing Address - Phone:412-913-8877
Mailing Address - Fax:
Practice Address - Street 1:1728 DUNLAWTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2922
Practice Address - Country:US
Practice Address - Phone:412-913-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19304261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery