Provider Demographics
NPI:1710055843
Name:SRINIDHI, PRATHIBA (DMD)
Entity Type:Individual
Prefix:
First Name:PRATHIBA
Middle Name:
Last Name:SRINIDHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 VAN BUREN RD APT 4
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2324
Mailing Address - Country:US
Mailing Address - Phone:856-772-1682
Mailing Address - Fax:610-872-1924
Practice Address - Street 1:64 VAN BUREN RD APT 4
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2324
Practice Address - Country:US
Practice Address - Phone:856-772-1682
Practice Address - Fax:610-872-1924
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031012-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice