Provider Demographics
NPI:1629143375
Name:CHODISETTY, JYOTHI (DDS)
Entity Type:Individual
Prefix:
First Name:JYOTHI
Middle Name:
Last Name:CHODISETTY
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 1:3424 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5093
Mailing Address - Country:US
Mailing Address - Phone:214-513-1300
Mailing Address - Fax:214-377-9694
Practice Address - Street 1:3424 LONG PRAIRIE RD
Practice Address - Street 2:SUITE #300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5093
Practice Address - Country:US
Practice Address - Phone:214-513-1300
Practice Address - Fax:214-377-9694
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29495122300000X
CO9215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist