MEDICARE: DR. SATHYASHREE SRIDHARA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1689747081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SATHYASHREE SRIDHARA D.D.S.

Provider Business Mailing Address
First Line	:	8826 S.ROBERTS ROAD
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1514
Country	:	US
Telephone Number	:	708-430-9540
Fax Number	:	708-430-5899

Provider Business Practice Location Address
First Line	:	8826 S. ROBERTS ROAD
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1514
Country	:	US
Telephone Number	:	708-430-9540
Fax Number	:	708-430-5899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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