Provider Demographics
NPI:1619081585
Name:SIRIVOLU, SUNITHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUNITHA
Middle Name:
Last Name:SIRIVOLU
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 1:11903 SOUTHERN BLVD
Mailing Address - Street 2:#116
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-795-7668
Mailing Address - Fax:561-795-7884
Practice Address - Street 1:11903 SOUTHERN BLVD
Practice Address - Street 2:#116
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7644
Practice Address - Country:US
Practice Address - Phone:561-795-7668
Practice Address - Fax:561-795-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice