Provider Demographics
NPI:1902211899
Name:PADMANABHAN, VARSHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VARSHA
Middle Name:
Last Name:PADMANABHAN
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 1:2302 SAM RAYBURN HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2696
Mailing Address - Country:US
Mailing Address - Phone:469-919-5605
Mailing Address - Fax:
Practice Address - Street 1:2302 SAM RAYBURN HWY STE 100
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2696
Practice Address - Country:US
Practice Address - Phone:469-919-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38067122300000X
MD16014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist