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General NPI Number Information
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NPI Number | 1023468790
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Entity Type | Individual
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Provider Name | SOORYA SRINIVASAN D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 305 W 12TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1267
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Country | US
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Telephone | 614-688-4047
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Fax |
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Provider Business Mailing Address
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Address Line | 5949 DUNHEATH LOOP
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City | DUBLIN
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State | OH
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Zip | 43016-7197
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Country | US
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Telephone | 508-514-0206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3664
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License Number State | OH
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