Individual
DR. SRICHARAN MAHAVADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
345 CONCORD AVE, BERKELEY SPRINGS, WV 25411-1235
(304) 258-2291
Mailing address
345 CONCORD AVE, BERKELEY SPRINGS, WV 25411-1235
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4339
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4339
DENTAL LICENSE NUMBER
WV
Enumeration date
06/28/2018
Last updated
06/28/2018
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