Provider Demographics
NPI:1659059582
Name:TADIKONDA, BHAVANA (BDS MBS)
Entity Type:Individual
Prefix:
First Name:BHAVANA
Middle Name:
Last Name:TADIKONDA
Suffix:
Gender:F
Credentials:BDS MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5969 E BROAD STREET SUITE 303
Mailing Address - Street 2:CLEVELAND DENTAL INSTITUTE MT CARMEL MEDICAL BUILDING 4
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-626-8822
Mailing Address - Fax:
Practice Address - Street 1:5969 E BROAD STREET SUITE 303
Practice Address - Street 2:CLEVELAND DENTAL INSTITUTE MT CARMEL MEDICAL BUILDING 4
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-626-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program