Provider Demographics
NPI:1043691165
Name:VADLAMANI, PRATHYUSHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRATHYUSHA
Middle Name:
Last Name:VADLAMANI
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 1:400 E DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-3714
Mailing Address - Country:US
Mailing Address - Phone:844-809-4163
Mailing Address - Fax:
Practice Address - Street 1:1756 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3277
Practice Address - Country:US
Practice Address - Phone:470-823-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100531223G0001X
NMDD47581223G0001X
IN12012340A1223G0001X
GADN1221951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice