Provider Demographics
NPI:1891928412
Name:SAVITHA SIDDAPPA DMD INC
Entity Type:Organization
Organization Name:SAVITHA SIDDAPPA DMD INC
Other - Org Name:PRISM DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-241-5353
Mailing Address - Street 1:355 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:SUITE A
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2973
Mailing Address - Country:US
Mailing Address - Phone:805-241-5353
Mailing Address - Fax:805-241-1515
Practice Address - Street 1:355 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:SUITE A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2973
Practice Address - Country:US
Practice Address - Phone:805-241-5353
Practice Address - Fax:805-241-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty