Provider Demographics
NPI:1679796684
Name:AVVARU, SREELATHA
Entity Type:Individual
Prefix:DR
First Name:SREELATHA
Middle Name:
Last Name:AVVARU
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 1:311 W RIVER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2635
Mailing Address - Country:US
Mailing Address - Phone:603-485-7600
Mailing Address - Fax:
Practice Address - Street 1:311 W RIVER RD STE 2
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-2635
Practice Address - Country:US
Practice Address - Phone:603-485-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303794Medicaid