Provider Demographics
NPI:1093294233
Name:NEKKANTI, DEVISREE (DMD)
Entity Type:Individual
Prefix:
First Name:DEVISREE
Middle Name:
Last Name:NEKKANTI
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 1:16301 DONOHER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4203
Mailing Address - Country:US
Mailing Address - Phone:732-428-9958
Mailing Address - Fax:
Practice Address - Street 1:7010 W HIGHWAY 71 STE 225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8341
Practice Address - Country:US
Practice Address - Phone:732-428-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358501223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45859384OtherDRIVERS LISCENCE
TX1093294233Medicaid