Individual
DR. SRIDHAR MEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1005 EAST LASALLE AVE, SOUTH BEND, IN 46617
(574) 245-7504
Mailing address
14983 FAIRFIELD DR, GRANGER, IN 46530
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011708
IN
1223G0001X
General Practice Dentistry
DN1855074
MA
Other
Enumeration date
06/08/2009
Last updated
10/12/2012
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