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General NPI Number Information
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NPI Number | 1114162930
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Entity Type | Individual
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Provider Name | PRIYADARSHINI SARIDE VENKATA D.D.S
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Gender | Female
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Dates
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Enumeration Date | 12/08/2008
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 530 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85004-1549
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Country | US
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Telephone | 682-386-2332
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Fax |
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Provider Business Mailing Address
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Address Line | 9010 S PRIEST DR APT 2142
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City | TEMPE
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State | AZ
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Zip | 85284-1087
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Country | US
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Telephone | 682-386-2332
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 056607-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 009954
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10904
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License Number State | AZ
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