Provider Demographics
NPI:1053669473
Name:BETHI, LAKSHMI (DMD)
Entity Type:Individual
Prefix:MRS
First Name:LAKSHMI
Middle Name:
Last Name:BETHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860HARRISON AVENUE
Mailing Address - Street 2:APT 302
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:215-421-7576
Mailing Address - Fax:
Practice Address - Street 1:555 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4101
Practice Address - Country:US
Practice Address - Phone:215-421-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 1855963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist