Provider Demographics
NPI:1013087642
Name:YENNA, SANTHI (DDS)
Entity Type:Individual
Prefix:MS
First Name:SANTHI
Middle Name:
Last Name:YENNA
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 1:2375 BOWES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-8500
Mailing Address - Country:US
Mailing Address - Phone:847-697-9900
Mailing Address - Fax:847-697-9910
Practice Address - Street 1:2375 BOWES RD STE 200
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-8500
Practice Address - Country:US
Practice Address - Phone:847-697-9900
Practice Address - Fax:847-697-9910
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist