Provider Demographics
NPI:1306194451
Name:BATHINA, VIJAYA LAKSHMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:LAKSHMI
Last Name:BATHINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1229
Mailing Address - Country:US
Mailing Address - Phone:806-420-9134
Mailing Address - Fax:
Practice Address - Street 1:794 KELLER PKWY STE A
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2490
Practice Address - Country:US
Practice Address - Phone:817-431-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560991223G0001X
IL019.0291811223G0001X
TX295161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice