Provider Demographics
NPI:1639433089
Name:NAMINENI, DEEPTI (DDS,)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:NAMINENI
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 1:4116 S CARRIER PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3243
Mailing Address - Country:US
Mailing Address - Phone:646-241-4964
Mailing Address - Fax:
Practice Address - Street 1:4116 S CARRIER PKWY STE 320
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3243
Practice Address - Country:US
Practice Address - Phone:972-262-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice