Provider Demographics
NPI:1912025990
Name:SRINIVASAN, SUNIL R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:R
Last Name:SRINIVASAN
Suffix:
Gender:M
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 1:990 W FREMONT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3021
Mailing Address - Country:US
Mailing Address - Phone:408-736-3696
Mailing Address - Fax:408-736-0376
Practice Address - Street 1:990 W FREMONT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3021
Practice Address - Country:US
Practice Address - Phone:408-736-3696
Practice Address - Fax:408-736-0376
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics