Provider Demographics
NPI:1609206135
Name:KADAVATH, SPRETHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SPRETHA
Middle Name:
Last Name:KADAVATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 WESTPORT TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1670
Mailing Address - Country:US
Mailing Address - Phone:973-641-6595
Mailing Address - Fax:
Practice Address - Street 1:50 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-777-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856427122300000X
NJ22DI02497200122300000X
PADS039775122300000X
CT11700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist