Provider Demographics
NPI:1386489011
Name:SIRIVOLU, KAPIL SAIKARAN (DMD)
Entity type:Individual
Prefix:
First Name:KAPIL
Middle Name:SAIKARAN
Last Name:SIRIVOLU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4489 MARINERS COVE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8373
Mailing Address - Country:US
Mailing Address - Phone:561-676-8256
Mailing Address - Fax:
Practice Address - Street 1:11903 SOUTHERN BLVD STE 116
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7644
Practice Address - Country:US
Practice Address - Phone:561-795-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty