Provider Demographics
NPI:1851071989
Name:MARU, SRAVYA
Entity Type:Individual
Prefix:DR
First Name:SRAVYA
Middle Name:
Last Name:MARU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14929 FLORENCE TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4632
Mailing Address - Country:US
Mailing Address - Phone:270-599-3670
Mailing Address - Fax:
Practice Address - Street 1:14929 FLORENCE TRL STE 200
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4632
Practice Address - Country:US
Practice Address - Phone:952-432-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist