Provider Demographics
NPI:1285180653
Name:THATIKONDA, SRI ARAVIND (DMD)
Entity Type:Individual
Prefix:
First Name:SRI ARAVIND
Middle Name:
Last Name:THATIKONDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 PADRON PL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-4429
Mailing Address - Country:US
Mailing Address - Phone:630-347-3417
Mailing Address - Fax:
Practice Address - Street 1:26219 INTERSTATE 45
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1903
Practice Address - Country:US
Practice Address - Phone:281-367-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0409281223G0001X
TX33768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice