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General NPI Number Information
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NPI Number | 1235442914
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Entity Type | Individual
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Provider Name | SRIDHAR REDDY SAGILI DDS
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Gender | Male
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 1500 SOUTHEAST 17TH STREET, BLDG 400
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City | OCALA
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State | FL
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Zip | 34471-5051
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Country | US
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Telephone | 352-502-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 362 LAKE DR
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City | OCALA
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State | FL
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Zip | 34472-5051
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Country | US
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Telephone | 225-329-3095
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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 | DN19674
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License Number State | FL
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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 | 0025829
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License Number State | TX
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