Provider Demographics
NPI:1326208919
Name:HARIBABU, VASANTHI (DDS)
Entity Type:Individual
Prefix:
First Name:VASANTHI
Middle Name:
Last Name:HARIBABU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:267-460-4254
Mailing Address - Fax:215-646-6199
Practice Address - Street 1:404 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE # 300
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1897
Practice Address - Country:US
Practice Address - Phone:215-757-4400
Practice Address - Fax:215-757-6405
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0374611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice