Provider Demographics
NPI:1851582415
Name:BODAPATI, SREEVIDYA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SREEVIDYA
Middle Name:
Last Name:BODAPATI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 N MOPAC EXPY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2414
Mailing Address - Country:US
Mailing Address - Phone:512-222-5721
Mailing Address - Fax:
Practice Address - Street 1:12319 N MOPAC EXPY
Practice Address - Street 2:SUITE 160
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2414
Practice Address - Country:US
Practice Address - Phone:512-222-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics