Provider Demographics
NPI:1710027065
Name:SANKARANARAYANAN, SRIVALLI (DDS)
Entity Type:Individual
Prefix:
First Name:SRIVALLI
Middle Name:
Last Name:SANKARANARAYANAN
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 1:1122 9TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-6413
Mailing Address - Country:US
Mailing Address - Phone:970-412-2098
Mailing Address - Fax:
Practice Address - Street 1:1122 9TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-6413
Practice Address - Country:US
Practice Address - Phone:970-412-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-93441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13224743Medicaid