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NPI Code Detail

MEDICARE: DR. SRIDHAR SISTA D.D.S.

MEDICARE:  DR. SRIDHAR  SISTA  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
11223G0001XGeneral Practice Dentistry0025616TX

General Provider Information

NPI Number : 1881915650
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SRIDHAR SISTA D.D.S.
Provider Business Mailing Address
First Line : 1355 W GRAY ST
Second Line :
City : HOUSTON
State : TX
Zip : 77019-4019
Country : US
Telephone Number : 713-526-2904
Fax Number :
Provider Business Practice Location Address
First Line : 1355 W GRAY ST
Second Line :
City : HOUSTON
State : TX
Zip : 77019-4019
Country : US
Telephone Number : 713-526-2904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2010
Last Update Date : 06/16/2010

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Directions to “ DR. SRIDHAR SISTA D.D.S.” Practice Location

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