Provider Demographics
NPI:1386152304
Name:BHAVANI SRIRAMANENI DMD PC
Entity type:Organization
Organization Name:BHAVANI SRIRAMANENI DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIRAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-662-9999
Mailing Address - Street 1:2305 W WILLIAM CANNON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5319
Mailing Address - Country:US
Mailing Address - Phone:512-444-3494
Mailing Address - Fax:512-444-3864
Practice Address - Street 1:2305 W WILLIAM CANNON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5319
Practice Address - Country:US
Practice Address - Phone:512-444-3494
Practice Address - Fax:512-444-3864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty