Healthcare Provider Details

I. General information

NPI: 1609522812
Provider Name (Legal Business Name): SRINIVAS DMD & ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 RICHARDSON RD STE 111
APEX NC
27523-8073
US

IV. Provider business mailing address

1481 RICHARDSON RD STE 111
APEX NC
27523-8073
US

V. Phone/Fax

Practice location:
  • Phone: 919-446-3131
  • Fax: 919-746-7588
Mailing address:
  • Phone: 919-446-3131
  • Fax: 919-746-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SRINIVAS REDDY MANDALA
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 919-446-3131