Provider Demographics
NPI:1437586963
Name:BADAM, ALEKHYA DEEPTHI
Entity Type:Individual
Prefix:
First Name:ALEKHYA DEEPTHI
Middle Name:
Last Name:BADAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 LUCILLE DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2865
Mailing Address - Country:US
Mailing Address - Phone:408-464-7233
Mailing Address - Fax:
Practice Address - Street 1:3292 ELIDA RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1249
Practice Address - Country:US
Practice Address - Phone:408-464-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0240901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice