Provider Demographics
NPI:1922196096
Name:EMANI, SREEKANTH R (DDS)
Entity Type:Individual
Prefix:MR
First Name:SREEKANTH
Middle Name:R
Last Name:EMANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 KNOX ABBOTT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3348
Mailing Address - Country:US
Mailing Address - Phone:803-233-6141
Mailing Address - Fax:803-832-0799
Practice Address - Street 1:1305 KNOX ABBOTT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3348
Practice Address - Country:US
Practice Address - Phone:803-233-6141
Practice Address - Fax:803-764-1410
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86321223G0001X, 1223G0001X
IL019027604122300000X
PADS036909122300000X
GADN013406122300000X
OH30022393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX8632Medicaid