Provider Demographics
NPI:1972764967
Name:GANNE, SRAVANTHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SRAVANTHI
Middle Name:
Last Name:GANNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 DUNLAWTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2923
Mailing Address - Country:US
Mailing Address - Phone:412-913-8877
Mailing Address - Fax:844-704-4268
Practice Address - Street 1:1728 DUNLAWTON AVE STE 3
Practice Address - Street 2:APARTMENT 2G
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2923
Practice Address - Country:US
Practice Address - Phone:412-913-8877
Practice Address - Fax:844-704-4268
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty