Provider Demographics
NPI:1891892758
Name:SUDEEP, LAKSHMY (DDS)
Entity Type:Individual
Prefix:
First Name:LAKSHMY
Middle Name:
Last Name:SUDEEP
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 1:3484 AMBRA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2053
Mailing Address - Country:US
Mailing Address - Phone:408-981-6255
Mailing Address - Fax:408-226-1621
Practice Address - Street 1:6950 SANTA TERESA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1300
Practice Address - Country:US
Practice Address - Phone:408-225-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist