Individual
SRINIVAS RAO MYNENI VENKATASATYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, PHD
Contact information
Practice address
108 ROCKLAND HL, STONY BROOK, NY 11794-8703
(631) 632-8739
Mailing address
7 PRESIDENTS DR, APT 4B, PORT JEFFERSON, NY 11777-2055
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
000063-1
NY
Other
Enumeration date
05/03/2016
Last updated
05/03/2016
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