Provider Demographics
NPI:1215415948
Name:VISHWANAT, LAKSHMI (DDS, MS)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:VISHWANAT
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HARMONY PARK XING APT NO1836
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4475
Mailing Address - Country:US
Mailing Address - Phone:210-243-8048
Mailing Address - Fax:
Practice Address - Street 1:3550 RAYFORD RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4343
Practice Address - Country:US
Practice Address - Phone:281-528-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist