Provider Demographics
NPI:1558709030
Name:VASARLA, SRAVANTHI VENKATA RAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SRAVANTHI
Middle Name:VENKATA RAO
Last Name:VASARLA
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 1:811 W SLAUGHTER LN
Mailing Address - Street 2:APT 2405
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6590
Mailing Address - Country:US
Mailing Address - Phone:737-703-8021
Mailing Address - Fax:
Practice Address - Street 1:5103 KYLE CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6164
Practice Address - Country:US
Practice Address - Phone:512-268-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist