Provider Demographics
NPI:1790935898
Name:SRIVASTAVA, MONIKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:SRIVASTAVA
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 1:1720 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1912
Mailing Address - Country:US
Mailing Address - Phone:215-485-7069
Mailing Address - Fax:
Practice Address - Street 1:1352 SOUTH ST # C5C4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1858
Practice Address - Country:US
Practice Address - Phone:267-909-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0388131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry