1700791241 NPI number — SHREYA GOUD EDULAKANTI SRIDHAR

Table of content: SHREYA GOUD EDULAKANTI SRIDHAR (NPI 1700791241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700791241 NPI number — SHREYA GOUD EDULAKANTI SRIDHAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDULAKANTI SRIDHAR
Provider First Name:
SHREYA GOUD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700791241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6810 CLUBHOUSE DR, APT D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-692-9498
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DENTAL DREAMS
Provider Second Line Business Practice Location Address:
3867 UNION DEPOSIT ROAD
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-558-0042
Provider Business Practice Location Address Fax Number:
717-558-0244
Provider Enumeration Date:
08/18/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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