Provider Demographics
NPI:1790510055
Name:SIRISHA KRISHNAMURTHY DDS INC
Entity type:Organization
Organization Name:SIRISHA KRISHNAMURTHY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-983-9800
Mailing Address - Street 1:2350 E BIDWELL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3627
Mailing Address - Country:US
Mailing Address - Phone:916-983-9800
Mailing Address - Fax:916-983-6100
Practice Address - Street 1:2350 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3627
Practice Address - Country:US
Practice Address - Phone:916-983-9800
Practice Address - Fax:916-983-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental