Provider Demographics
NPI:1184301079
Name:SRIVASTAVA, PARAG
Entity type:Individual
Prefix:
First Name:PARAG
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N URSULA ST UNIT 214
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7408
Mailing Address - Country:US
Mailing Address - Phone:650-452-2924
Mailing Address - Fax:
Practice Address - Street 1:3737 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-7510
Practice Address - Country:US
Practice Address - Phone:720-923-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX403511223G0001X
CODEN.00205708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice