Provider Demographics
NPI:1922101542
Name:BHAVANI D SRIRAMANENI DMD PC
Entity Type:Organization
Organization Name:BHAVANI D SRIRAMANENI DMD PC
Other - Org Name:HOLLISTON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVANI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SRIRAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-346-3161
Mailing Address - Street 1:35 NORTHERN SPY RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:508-346-3161
Mailing Address - Fax:508-346-3161
Practice Address - Street 1:21 CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:02038
Practice Address - Country:US
Practice Address - Phone:508-429-5666
Practice Address - Fax:508-893-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty