Provider Demographics
NPI:1053651588
Name:PERNAPATI, LAVANYA (BDS)
Entity Type:Individual
Prefix:
First Name:LAVANYA
Middle Name:
Last Name:PERNAPATI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STARBOARD SIDE LN
Mailing Address - Street 2:APT 102
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2283
Mailing Address - Country:US
Mailing Address - Phone:585-275-5051
Mailing Address - Fax:
Practice Address - Street 1:2100 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3452
Practice Address - Country:US
Practice Address - Phone:585-275-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY107956673OtherDRIVING LICENSE NUMBER