Provider Demographics
NPI:1841784980
Name:KEESARA, SREELAKSHMI (DDS)
Entity Type:Individual
Prefix:
First Name:SREELAKSHMI
Middle Name:
Last Name:KEESARA
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 1:549 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1365
Mailing Address - Country:US
Mailing Address - Phone:317-535-7522
Mailing Address - Fax:317-535-5115
Practice Address - Street 1:549 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1365
Practice Address - Country:US
Practice Address - Phone:317-535-7522
Practice Address - Fax:317-535-5115
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012954A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12012954AMedicaid