Provider Demographics
NPI:1912294315
Name:SREEDHARAN, REEME KOPPULLI (DMD)
Entity Type:Individual
Prefix:DR
First Name:REEME
Middle Name:KOPPULLI
Last Name:SREEDHARAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 APPLE DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-3140
Mailing Address - Country:US
Mailing Address - Phone:484-467-0102
Mailing Address - Fax:
Practice Address - Street 1:351 W SCHUYLKILL RD STE G-15A
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7438
Practice Address - Country:US
Practice Address - Phone:610-326-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist