Provider Demographics
NPI:1598322984
Name:INAMPUDI, LAVANYA REKHA (DDS)
Entity Type:Individual
Prefix:
First Name:LAVANYA
Middle Name:REKHA
Last Name:INAMPUDI
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 1:19089 GALLOWAY CIR
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:MN
Mailing Address - Zip Code:55340-3400
Mailing Address - Country:US
Mailing Address - Phone:763-203-1766
Mailing Address - Fax:
Practice Address - Street 1:8960 SPRINGBROOK DR NW STE 150
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5809
Practice Address - Country:US
Practice Address - Phone:763-784-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist