Provider Demographics
NPI:1669808259
Name:SRIVASTAVA, PRIYANKA (DDS)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:SRIVASTAVA
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 1:1008 TIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9159
Mailing Address - Country:US
Mailing Address - Phone:717-215-3652
Mailing Address - Fax:
Practice Address - Street 1:1073 OAK ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3716
Practice Address - Country:US
Practice Address - Phone:570-655-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist