Provider Demographics
NPI:1396402442
Name:VATTIKUNTA, LAHARI (BDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAHARI
Middle Name:
Last Name:VATTIKUNTA
Suffix:
Gender:F
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 N ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2224
Mailing Address - Country:US
Mailing Address - Phone:918-451-2717
Mailing Address - Fax:
Practice Address - Street 1:765 N ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2224
Practice Address - Country:US
Practice Address - Phone:918-451-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics