Provider Demographics
NPI:1336734052
Name:S. DAVE SRIKUREJA DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:S. DAVE SRIKUREJA DDS, A PROFESSIONAL CORPORATION
Other - Org Name:MONTCLAIR PLAZA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUTHEEP
Authorized Official - Middle Name:DAVE
Authorized Official - Last Name:SRIKUREJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-920-0696
Mailing Address - Street 1:8660 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1692
Mailing Address - Country:US
Mailing Address - Phone:909-920-0696
Mailing Address - Fax:909-920-0517
Practice Address - Street 1:8660 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1692
Practice Address - Country:US
Practice Address - Phone:909-920-0696
Practice Address - Fax:909-920-0517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S. DAVE SRIKUREJA DDS, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental