Provider Demographics
NPI:1720217953
Name:VEDULLAPALLI, RATNA LALITHA
Entity Type:Individual
Prefix:
First Name:RATNA
Middle Name:LALITHA
Last Name:VEDULLAPALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W ERIE ST
Mailing Address - Street 2:STE ST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6914
Mailing Address - Country:US
Mailing Address - Phone:920-838-1649
Mailing Address - Fax:
Practice Address - Street 1:430 W ERIE ST
Practice Address - Street 2:STE ST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6914
Practice Address - Country:US
Practice Address - Phone:920-838-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0379881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice