Provider Demographics
NPI:1457845174
Name:KOLLI, RANVITA PRIYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANVITA
Middle Name:PRIYA
Last Name:KOLLI
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 1:5873 ALDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-4418
Mailing Address - Country:US
Mailing Address - Phone:408-431-1668
Mailing Address - Fax:
Practice Address - Street 1:3658 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1239
Practice Address - Country:US
Practice Address - Phone:317-614-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012960A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice