Healthcare Provider Details

I. General information

NPI: 1699221218
Provider Name (Legal Business Name): JAYASHREE SRINIVASAN DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 PANSY ST SW
HUNTSVILLE AL
35801-3804
US

IV. Provider business mailing address

2331 PANSY STREET
HUNTSVILLE AL
35801-3804
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-7700
  • Fax:
Mailing address:
  • Phone: 256-533-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6088
License Number StateAL

VIII. Authorized Official

Name: DR. JAYASHREE SRINIVASAN
Title or Position: OWNER
Credential: DMD
Phone: 334-524-2738