Provider Demographics
NPI:1972852309
Name:BHAMIDIPATY, SIRISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:BHAMIDIPATY
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 1:1533 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4325
Mailing Address - Country:US
Mailing Address - Phone:360-654-6464
Mailing Address - Fax:
Practice Address - Street 1:1533 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4325
Practice Address - Country:US
Practice Address - Phone:360-654-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603055221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice