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Contact Information

SRIDHAR MEDA, DMD
1005 EAST LASALLE AVE
SOUTH BEND, IN46617
 Phone: 574-245-7504
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for SRIDHAR MEDA · (Male)

NPI # 1225264054
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 06/08/2009
Last updated 10/12/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 12011708
  • MA License # DN1855074
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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