Provider Demographics
NPI:1205362928
Name:HARICHANDANA VEMIREDDY DMD PLLC
Entity Type:Organization
Organization Name:HARICHANDANA VEMIREDDY DMD PLLC
Other - Org Name:TRINITY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HARICHANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-416-7136
Mailing Address - Street 1:1000 WEST ROSEMEADE PARKWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007
Mailing Address - Country:US
Mailing Address - Phone:972-394-5200
Mailing Address - Fax:
Practice Address - Street 1:1000 WEST ROSEMEADE PARKWAY STE 100
Practice Address - Street 2:
Practice Address - City:CARROLTON
Practice Address - State:TX
Practice Address - Zip Code:75007
Practice Address - Country:US
Practice Address - Phone:972-394-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28505OtherDENTAL LICENSE