Provider Demographics
NPI:1912429994
Name:PAPISETTI, SRAVANTHI (BDS)
Entity Type:Individual
Prefix:
First Name:SRAVANTHI
Middle Name:
Last Name:PAPISETTI
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 1:545 OVERTURE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-0076
Mailing Address - Country:US
Mailing Address - Phone:304-384-0608
Mailing Address - Fax:
Practice Address - Street 1:1320 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5844
Practice Address - Country:US
Practice Address - Phone:304-384-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013928A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12055OtherRESIDENT DENTIST LICENSE