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General NPI Number Information
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NPI Number | 1669808259
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Entity Type | Individual
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Provider Name | PRIYANKA SRIVASTAVA DDS
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 1073 OAK ST
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City | PITTSTON
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State | PA
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Zip | 18640-3716
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Country | US
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Telephone | 570-655-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 TIVERTON RD
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City | MECHANICSBURG
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State | PA
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Zip | 17050-9159
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Country | US
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Telephone | 717-215-3652
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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 | DS039997
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License Number State | PA
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