Provider Demographics
NPI:1821744368
Name:YELLAMANCHILI DENTAL CORP
Entity Type:Organization
Organization Name:YELLAMANCHILI DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:YELLAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-529-9085
Mailing Address - Street 1:1490 EUREKA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2825
Mailing Address - Country:US
Mailing Address - Phone:916-409-3979
Mailing Address - Fax:
Practice Address - Street 1:1490 EUREKA RD STE 130
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2825
Practice Address - Country:US
Practice Address - Phone:916-409-3979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty