Provider Demographics
NPI:1699221218
Name:JAYASHREE SRINIVASAN DMD LLC
Entity Type:Organization
Organization Name:JAYASHREE SRINIVASAN DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYASHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-524-2738
Mailing Address - Street 1:2331 PANSY STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3804
Mailing Address - Country:US
Mailing Address - Phone:256-533-7700
Mailing Address - Fax:
Practice Address - Street 1:2331 PANSY ST SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3804
Practice Address - Country:US
Practice Address - Phone:256-533-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6088261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental