Provider Demographics
NPI:1285146589
Name:MUNIMADUGU, SIRISHA (BDS)
Entity type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:MUNIMADUGU
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:DR
Other - First Name:SIRISHA
Other - Middle Name:
Other - Last Name:MUNIMADUGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4603 158TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3251
Mailing Address - Country:US
Mailing Address - Phone:408-431-5168
Mailing Address - Fax:
Practice Address - Street 1:3302 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2013
Practice Address - Country:US
Practice Address - Phone:214-828-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327751223P0300X
WADE609511761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics