Provider Demographics
NPI:1073404158
Name:KALLURI, SAIBHARADWAJA (DDS)
Entity type:Individual
Prefix:DR
First Name:SAIBHARADWAJA
Middle Name:
Last Name:KALLURI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WOODBURY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4949
Mailing Address - Country:US
Mailing Address - Phone:651-731-1010
Mailing Address - Fax:
Practice Address - Street 1:580 WOODBURY DR STE 300
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4949
Practice Address - Country:US
Practice Address - Phone:651-731-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist