SIREESHA KODALI (NPI# 1447608443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447608443 |
| Entity Type | Individual |
| Full Name | SIREESHA KODALI |
| Credential | DMD |
| Practice Address |
4145 N 108th Ave Phoenix AZ 85037 |
| Mailing Address |
2514 E Barbed Wire Pass Phoenix AZ 85024-5231 |
| Practice Telephone | 6233442000 |
| Practice Fax Number | 6233443007 |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2019-09-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9876 | AZ | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 9770 | KY | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 789 Eastern Pkwy Apt 2, Louisville, KY 402171978 | 5026444640 |
| Street Address |
4145 N 108TH AVE |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619021490 | Arizona Pediatric Dentistry and Orthodontic | Dentist | 4145 N 108th Ave, Bldg K-101, Phoenix, AZ 85037-5463 | 2007-01-22 |
| 1265774251 | Henry D Martinez | Dentist | 4145 N 108th Ave, Phoenix, AZ 85037-5463 | 2013-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356969828 | Live Well Assisted Living LLC | Psychiatric Residential Treatment Facility | 9210 W Loow Bend Lane, Phoenix, AZ 85037 | 2020-07-10 |
| 1770126260 | Medical Management Systems, Inc. | Assisted Living Facility | 2209 N. Rascon Loop, Phoenix, AZ 85037 | 2019-10-28 |
| 1346800760 | Sonoran Sky Family Dentistry | Dentist | 9515 West Camelback Road, Suite #120, Phoenix, AZ 85037 | 2019-06-18 |
| 1578025136 | Jennifer Natasha Kunz | Nurse Practitioner | Cleanslate, 8410 W. Thomas Rd, Phoenix, AZ 85037 | 2019-04-03 |
| 1740751320 | Mariposa Phoenix Al Partners, Lp | Assisted Living Facility | 3100 N 91st Avenue, Phoenix, AZ 85037 | 2018-12-08 |
| 1417442799 | Prop Anesthesia LLC | Nurse Anesthetist, Certified Registered | 9250 W Thomas Rd Ste 220, Phoenix, AZ 85037 | 2018-06-28 |
| 1922522242 | Tree of Life Mental Health Systems, LLC | Behavior Technician | 8400 W. Virginia, #1138, Phoenix, AZ 85037 | 2017-07-28 |
| 1720500465 | Moc Phoenix, LLC | Assisted Living Facility | 3000 N. 91st Avenue, Phoenix, AZ 85037 | 2017-07-14 |
| 1407385826 | Not Alone Home Care, LLC | In Home Supportive Care | 9422 W Palm Lane, Phoenix, AZ 85037 | 2017-06-08 |
| 1063953081 | Karla Soward | Radiologic Technologist | 2015 N Rascon Loop, Phoenix, AZ 85037 | 2017-03-09 |
| Find all providers in zip 85037 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881206274 | Totally Kids Dental P.C. | Dentist | 602 W Union Hills Dr Ste 9, Phoenix, AZ 85027-6629 | 2020-08-18 |
| 1861989121 | Logan Mariano | Dentist | 4383 E Rosemonte Dr, Phoenix, AZ 85050-3407 | 2018-04-21 |
| 1972023372 | David Jourabchi | Dentist | 4550 E Bell Rd Ste 106, Phoenix, AZ 85032-9342 | 2017-06-27 |
| 1730639840 | Steven Petruzzi Dds Pllc | Dentist | 34406 N 27th Dr Ste 106, Phoenix, AZ 85085-7730 | 2016-10-12 |
| 1124401146 | Jennifer Canada | Dentist | 6725 N 35th Ave # 105, Phoenix, AZ 85017-1083 | 2015-07-08 |
| 1548654791 | Arlene Kewallal | Dentist | 1935 W Happy Valley Rd, Phoenix, AZ 85085-2884 | 2015-03-25 |
| 1134400880 | Norterra Pediatric Dental Partners, LLP | Dentist | 2217 W Happy Valley Rd Ste 100, Phoenix, AZ 85085-1604 | 2011-09-07 |
| 1558689703 | Hamed Rezakhan | Dentist | 4803 E Ray Rd, Suit P002c, Phoenix, AZ 85044-6496 | 2010-05-12 |
| 1417110750 | Shreekrishna Chaitanya Akilesh | Dentist | 10550 W Mariposa St, Phoenix, AZ 85037-5081 | 2008-07-07 |
| 1134345937 | Pda Holdings | Dentist | 1701 E Thomas Rd #204, Phoenix, AZ 85016 | 2007-04-18 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.