Provider Demographics
NPI:1144742891
Name:MENDU, PRATHYUSHA (DDS)
Entity Type:Individual
Prefix:
First Name:PRATHYUSHA
Middle Name:
Last Name:MENDU
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 1:4700 S RIDGE RD APT 513
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2263
Mailing Address - Country:US
Mailing Address - Phone:773-679-8709
Mailing Address - Fax:
Practice Address - Street 1:5080 VIRGINIA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5600
Practice Address - Country:US
Practice Address - Phone:972-301-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice