Individual
BHARATH VAMSI KRISHN SREEKANTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
401 N VETERANS PKWY STE 4, BLOOMINGTON, IL 61704-7716
(267) 394-3903
Mailing address
132 AFFINITY LN APT C, BUFFALO, NY 14215-2483
(267) 394-3903
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031751
IL
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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