Active NPI
Bharath Vamsi Krishn Sreekantam, DDS
- General Practice Dentistry
- Bloomington, IL
National Provider Identifier
1265926745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.031751
- Practice address
- 401 N Veterans Pkwy Ste 4
Bloomington, IL 61704-7716 - Phone
- (267) 394-3903
- NPI assigned
- Jun 19, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.031751 | IL | Primary |
Addresses
Primary practice location
401 N Veterans Pkwy Ste 4
Bloomington, IL 61704-7716
Mailing address
132 Affinity LN Apt C
Buffalo, NY 14215-2483
Phone (267) 394-3903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031751 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529366400000",
"number": "1265926745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "132 AFFINITY LN APT C",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142152483",
"telephone_number": "267-394-3903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 N VETERANS PKWY STE 4",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617047716",
"telephone_number": "267-394-3903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SREEKANTAM",
"first_name": "BHARATH VAMSI KRISHN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-19",
"last_updated": "2018-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.031751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.