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General NPI Number Information
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NPI Number | 1134534266
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Entity Type | Individual
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Provider Name | SRIDHAR KRISHNA CHINTA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 3429 LAWRENCEVILLE SUWANEE RD STE E-F
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City | SUWANEE
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State | GA
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Zip | 30024-2433
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Country | US
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Telephone | 678-765-9133
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Fax |
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Provider Business Mailing Address
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Address Line | 5890 THOROUGHBRED WAY
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City | SUWANEE
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State | GA
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Zip | 30024-2144
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Country | US
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Telephone | 817-718-8397
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30188
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015980
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License Number State | GA
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