Healthcare Provider Details

I. General information

NPI: 1336450287
Provider Name (Legal Business Name): SRIDEVI BABU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 CLARENDON BLVD
ARLINGTON VA
22209-2741
US

IV. Provider business mailing address

1731 CLARENDON BLVD
ARLINGTON VA
22209-2741
US

V. Phone/Fax

Practice location:
  • Phone: 703-812-8800
  • Fax: 703-812-8802
Mailing address:
  • Phone: 703-812-8800
  • Fax: 703-812-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10376
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855464
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27725
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: