Provider Demographics
NPI:1164924379
Name:YANNAM, SAVITHA DEEPTHI (BDS,MDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:SAVITHA
Middle Name:DEEPTHI
Last Name:YANNAM
Suffix:
Gender:F
Credentials:BDS,MDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 GATEWAY BLVD E STE 101
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1802
Mailing Address - Country:US
Mailing Address - Phone:915-444-5121
Mailing Address - Fax:
Practice Address - Street 1:7878 GATEWAY BLVD E STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1802
Practice Address - Country:US
Practice Address - Phone:915-444-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0263731223P0221X
TX370631223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry