Provider Demographics
NPI:1003664459
Name:LAKSHMI DDS PLLC
Entity type:Organization
Organization Name:LAKSHMI DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MYLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-528-8455
Mailing Address - Street 1:507 E HELENA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1830
Mailing Address - Country:US
Mailing Address - Phone:571-528-8455
Mailing Address - Fax:
Practice Address - Street 1:1776 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5505
Practice Address - Country:US
Practice Address - Phone:571-528-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty