Provider Demographics
NPI:1689661381
Name:VASANTHA, SREEMALI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SREEMALI
Middle Name:
Last Name:VASANTHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PLEASANT ST
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3831
Mailing Address - Country:US
Mailing Address - Phone:603-225-4143
Mailing Address - Fax:603-226-9413
Practice Address - Street 1:102 PLEASANT ST
Practice Address - Street 2:SUITE # 3
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3831
Practice Address - Country:US
Practice Address - Phone:603-225-4143
Practice Address - Fax:603-226-9413
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303629Medicaid