Provider Demographics
NPI:1649412453
Name:MALINENI, SMITHA CHOWDARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SMITHA
Middle Name:CHOWDARY
Last Name:MALINENI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SMITHA
Other - Middle Name:CHOWDARY
Other - Last Name:KANCHERLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10703 CLUB CHASE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9435
Mailing Address - Country:US
Mailing Address - Phone:312-505-7514
Mailing Address - Fax:
Practice Address - Street 1:133 W MARKET ST
Practice Address - Street 2:#270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2801
Practice Address - Country:US
Practice Address - Phone:312-505-7514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027015122300000X
IN12011551A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist