Provider Demographics
NPI:1780772954
Name:SRIKANTAM, SOWJANYA (BDS)
Entity type:Individual
Prefix:DR
First Name:SOWJANYA
Middle Name:
Last Name:SRIKANTAM
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 STONEHENGE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5578
Mailing Address - Country:US
Mailing Address - Phone:510-790-1814
Mailing Address - Fax:
Practice Address - Street 1:2324 SANTA RITA RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4152
Practice Address - Country:US
Practice Address - Phone:925-249-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice