Provider Demographics
NPI:1538473756
Name:YANALA, KIRAN M (DMD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:M
Last Name:YANALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 W CAMINO DEL ARCO
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-0979
Mailing Address - Country:US
Mailing Address - Phone:973-220-4615
Mailing Address - Fax:
Practice Address - Street 1:2110 W SLAUGHTER LN STE 190
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5997
Practice Address - Country:US
Practice Address - Phone:512-593-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3587122300000X
TX26283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist