Provider Demographics
NPI:1205506615
Name:KASTALA, SRI LAKSHMI SILPA
Entity type:Individual
Prefix:DR
First Name:SRI LAKSHMI SILPA
Middle Name:
Last Name:KASTALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 W MCDOWELL RD STE 1001
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4865
Mailing Address - Country:US
Mailing Address - Phone:623-242-6001
Mailing Address - Fax:623-242-6006
Practice Address - Street 1:10320 W MCDOWELL RD STE 1001
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4865
Practice Address - Country:US
Practice Address - Phone:623-242-6001
Practice Address - Fax:623-242-6006
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO111731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice