Provider Demographics
NPI:1508038712
Name:SARAT NALLURI, DDS, INC.
Entity Type:Organization
Organization Name:SARAT NALLURI, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-629-9021
Mailing Address - Street 1:7067 TIFFANY BLVD STE 260
Mailing Address - Street 2:P.O. BOX 5410
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1958
Mailing Address - Country:US
Mailing Address - Phone:330-629-9021
Mailing Address - Fax:330-965-9237
Practice Address - Street 1:7067 TIFFANY BLVD STE 260
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1958
Practice Address - Country:US
Practice Address - Phone:330-629-9021
Practice Address - Fax:330-965-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300209011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2109668Medicaid