Basic Information
| Provider Information | |||||||||
| NPI: | 1538775028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SRAVAN KUMAR | ||||||||
| FirstName: | MEERA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 BLOSSOM HILL RD STE 20 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951231658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083373622 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 451 BLOSSOM HILL RD STE 20 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951231658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083373622 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2020 | ||||||||
| LastUpdateDate: | 09/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 105540 | CA | Y | Dental Providers | Dentist |
No ID Information.