Healthcare Provider Details

I. General information

NPI: 1801028899
Provider Name (Legal Business Name): SRIDHAR V K ESWARAN BDS., M.S., M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 M D ANDERSON BLVD SUITE # 310
HOUSTON TX
77030-3402
US

IV. Provider business mailing address

6516 M D ANDERSON BLVD SUITE # 310
HOUSTON TX
77030-3402
US

V. Phone/Fax

Practice location:
  • Phone: 832-623-4507
  • Fax: 713-500-4393
Mailing address:
  • Phone: 832-623-4507
  • Fax: 713-500-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number24847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: