Provider Demographics
NPI:1689737785
Name:MYNENI, BHARATHI DEVI (BDS)
Entity Type:Individual
Prefix:DR
First Name:BHARATHI DEVI
Middle Name:
Last Name:MYNENI
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 SW NAHCOTTA DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5775
Mailing Address - Country:US
Mailing Address - Phone:503-590-2586
Mailing Address - Fax:
Practice Address - Street 1:13575 SW NAHCOTTA DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5775
Practice Address - Country:US
Practice Address - Phone:503-590-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics