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General NPI Number Information
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NPI Number | 1972764967
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Entity Type | Individual
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Provider Name | SRAVANTHI GANNE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 1728 DUNLAWTON AVE STE 3 APARTMENT 2G
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City | PORT ORANGE
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State | FL
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Zip | 32127-2923
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Country | US
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Telephone | 412-913-8877
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Fax | 844-704-4268
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Provider Business Mailing Address
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Address Line | 1728 DUNLAWTON AVE STE 3
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City | PORT ORANGE
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State | FL
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Zip | 32127-2923
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Country | US
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Telephone | 412-913-8877
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Fax | 844-704-4268
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN19304
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License Number State | FL
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