MEDICARE: PRIYANKA SRIVASTAVA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS039997	PA

General Provider Information

NPI Number	:	1669808259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA SRIVASTAVA DDS

Provider Business Mailing Address
First Line	:	1008 TIVERTON RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17050-9159
Country	:	US
Telephone Number	:	717-215-3652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1073 OAK ST
Second Line	:
City	:	PITTSTON
State	:	PA
Zip	:	18640-3716
Country	:	US
Telephone Number	:	570-655-4141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	04/25/2017

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