Active NPI
Surendra Gopal Sirivolu, DDS MHA
- General Practice Dentistry
- Orlando, FL
National Provider Identifier
1356467930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN17057
- Practice address
- 1768 Park Center Dr
Suite # 230
Orlando, FL 32835-6200 - Phone
- (407) 532-0192
- Fax
- (407) 532-3091
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | DN17057 | FL | Primary |
Addresses
Primary practice location
1768 Park Center Dr
Suite # 230
Orlando, FL 32835-6200
Mailing address
1768 Park Center Dr
Suite # 230
Orlando, FL 32835-6200
Phone (407) 532-0192
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DN17057 | Other | FL | DENTAL LICENSE |
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 |
|---|---|---|---|
| DN17057 | FL | MD | General Practice Dentistry |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356467930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1768 PARK CENTER DR",
"address_2": "SUITE # 230",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328356200",
"telephone_number": "407-532-0192",
"fax_number": "407-532-3091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1768 PARK CENTER DR",
"address_2": "SUITE # 230",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328356200",
"telephone_number": "407-532-0192",
"fax_number": "407-532-3091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIRIVOLU",
"first_name": "SURENDRA",
"middle_name": "GOPAL",
"name_prefix": "Dr.",
"credential": "DDS MHA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN17057",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "DN17057",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.