Provider Demographics
NPI:1639787021
Name:SRIVASTAVA, AMBIKA RANI (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:AMBIKA
Middle Name:RANI
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MCFARLAND BLVD N STE D
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2236
Mailing Address - Country:US
Mailing Address - Phone:205-758-3341
Mailing Address - Fax:
Practice Address - Street 1:1825 MCFARLAND BLVD N STE D
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2236
Practice Address - Country:US
Practice Address - Phone:205-758-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4144-201223G0001X
ALD0007097-C11223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist