Provider Demographics
NPI:1013741016
Name:ADMIRE DENTAL PLLC
Entity type:Organization
Organization Name:ADMIRE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SRI ARAVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:THATIKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-347-3417
Mailing Address - Street 1:2213 PADRON PL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-4429
Mailing Address - Country:US
Mailing Address - Phone:630-347-3417
Mailing Address - Fax:
Practice Address - Street 1:17462 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1002
Practice Address - Country:US
Practice Address - Phone:713-244-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty