Provider Demographics
NPI:1437592516
Name:YELISETTY, RAMA KRISHNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAMA
Middle Name:KRISHNA
Last Name:YELISETTY
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 1:368 HARBISON BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2248
Mailing Address - Country:US
Mailing Address - Phone:803-234-2320
Mailing Address - Fax:803-781-5219
Practice Address - Street 1:368 HARBISON BLVD
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2248
Practice Address - Country:US
Practice Address - Phone:803-234-2320
Practice Address - Fax:803-781-5219
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8185 GD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist