Provider Demographics
NPI:1265660948
Name:KOMMINENI, PADMALATHA
Entity Type:Individual
Prefix:
First Name:PADMALATHA
Middle Name:
Last Name:KOMMINENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PADMALATHA
Other - Middle Name:
Other - Last Name:BOYAPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4000 SCENIC RIVER LN
Mailing Address - Street 2:APT 3D
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-7504
Mailing Address - Country:US
Mailing Address - Phone:661-679-4259
Mailing Address - Fax:661-679-4259
Practice Address - Street 1:1491 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-4677
Practice Address - Country:US
Practice Address - Phone:661-827-9183
Practice Address - Fax:661-827-9185
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist