Provider Demographics
NPI:1598084352
Name:SRI, ANUBAMA
Entity Type:Individual
Prefix:DR
First Name:ANUBAMA
Middle Name:
Last Name:SRI
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 1:729 SUNRISE AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4565
Mailing Address - Country:US
Mailing Address - Phone:916-781-3737
Mailing Address - Fax:
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:STE. 101
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4565
Practice Address - Country:US
Practice Address - Phone:916-781-3737
Practice Address - Fax:916-781-6648
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590351223G0001X
KS607041223G0001X
MO20090205151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice