Provider Demographics
NPI:1568669554
Name:ANANTATMULA, BRIAN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:H
Last Name:ANANTATMULA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EASTMONT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-7665
Mailing Address - Country:US
Mailing Address - Phone:509-886-2345
Mailing Address - Fax:509-886-2611
Practice Address - Street 1:801 EASTMONT AVE STE A
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7665
Practice Address - Country:US
Practice Address - Phone:509-886-2345
Practice Address - Fax:509-886-2611
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000108941223G0001X
IDD40641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice