Provider Demographics
NPI:1689358996
Name:KATAMNENI, SRUTHI (DDS)
Entity Type:Individual
Prefix:
First Name:SRUTHI
Middle Name:
Last Name:KATAMNENI
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 1:7797 EDELWEISS TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0381
Mailing Address - Country:US
Mailing Address - Phone:681-888-3366
Mailing Address - Fax:
Practice Address - Street 1:JEFFERSON DENTAL & ORTHODONTICS
Practice Address - Street 2:4396 TOM LANDRY FWY, I-30
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75223
Practice Address - Country:US
Practice Address - Phone:214-451-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice