Provider Demographics
NPI:1134534266
Name:CHINTA, SRIDHAR KRISHNA (DDS)
Entity type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:KRISHNA
Last Name:CHINTA
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 1:5890 THOROUGHBRED WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2144
Mailing Address - Country:US
Mailing Address - Phone:817-718-8397
Mailing Address - Fax:
Practice Address - Street 1:3429 LAWRENCEVILLE SUWANEE RD STE E-F
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2433
Practice Address - Country:US
Practice Address - Phone:678-765-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301881223G0001X
GADN0159801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice