Healthcare Provider Details

I. General information

NPI: 1639787021
Provider Name (Legal Business Name): AMBIKA RANI SRIVASTAVA DMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MCFARLAND BLVD N STE D
TUSCALOOSA AL
35406-2236
US

IV. Provider business mailing address

1825 MCFARLAND BLVD N STE D
TUSCALOOSA AL
35406-2236
US

V. Phone/Fax

Practice location:
  • Phone: 205-758-3341
  • Fax:
Mailing address:
  • Phone: 205-758-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD0007097-C1
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4144-20
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number163917
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD0007097-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: