Provider Demographics
NPI:1962758284
Name:KRISHNAMURTHY, SIRISHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:KRISHNAMURTHY
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 1:2350 E BIDWELL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3455
Mailing Address - Country:US
Mailing Address - Phone:916-983-9800
Mailing Address - Fax:916-983-6100
Practice Address - Street 1:2350 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-983-9800
Practice Address - Fax:916-983-6100
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice