Provider Demographics
NPI:1336450287
Name:BABU, SRIDEVI (DMD)
Entity type:Individual
Prefix:DR
First Name:SRIDEVI
Middle Name:
Last Name:BABU
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 1:1731 CLARENDON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2741
Mailing Address - Country:US
Mailing Address - Phone:703-812-8800
Mailing Address - Fax:703-812-8802
Practice Address - Street 1:1731 CLARENDON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2741
Practice Address - Country:US
Practice Address - Phone:703-812-8800
Practice Address - Fax:703-812-8802
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10376122300000X
MADN1855464122300000X
TX27725122300000X
VA0401414280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist