Provider Demographics
NPI:1962075135
Name:KARRI, PAVANI PRIYANKA (DDS)
Entity type:Individual
Prefix:
First Name:PAVANI PRIYANKA
Middle Name:
Last Name:KARRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 DECOTO RD APT 38
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4473
Mailing Address - Country:US
Mailing Address - Phone:650-690-6934
Mailing Address - Fax:
Practice Address - Street 1:8201 EDGEWATER DR STE 106
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2021
Practice Address - Country:US
Practice Address - Phone:510-568-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1066751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice