Provider Demographics
NPI:1689747081
Name:SRIDHARA, SATHYASHREE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SATHYASHREE
Middle Name:
Last Name:SRIDHARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 S.ROBERTS ROAD
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1514
Mailing Address - Country:US
Mailing Address - Phone:708-430-9540
Mailing Address - Fax:708-430-5899
Practice Address - Street 1:8826 S. ROBERTS ROAD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1514
Practice Address - Country:US
Practice Address - Phone:708-430-9540
Practice Address - Fax:708-430-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice