Provider Demographics
NPI:1720790991
Name:TENTH STREET FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:TENTH STREET FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSHANAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-215-4687
Mailing Address - Street 1:6919 E 10TH ST STE A1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4811
Mailing Address - Country:US
Mailing Address - Phone:317-358-8885
Mailing Address - Fax:317-358-8886
Practice Address - Street 1:6919 E 10TH ST STE A1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4811
Practice Address - Country:US
Practice Address - Phone:317-358-8885
Practice Address - Fax:317-358-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty