Healthcare Provider Details

I. General information

NPI: 1821820481
Provider Name (Legal Business Name): SRIMANTH ALLURI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/15/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDING OFFICER, NAVAL MEDICAL CENTER 100 BREWSTER BLVD
FPO AA
28547
US

IV. Provider business mailing address

9040 STAR SHOWER DR
ROSEVILLE CA
95747-4579
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4300
  • Fax:
Mailing address:
  • Phone: 925-640-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14098453-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: