Individual
DR. SHRUTHI Y BANNENAHALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
213 MAIN ST, BLYTHEWOOD, SC 29016-8504
(803) 753-9545
Mailing address
517 PALM SEDGE LOOP # A-5, ELGIN, SC 29045-8007
(407) 687-3470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8707
SC
1223G0001X
General Practice Dentistry
Primary
DS037727
PA
Other
Enumeration date
02/21/2009
Last updated
01/21/2026
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