Provider Demographics
NPI:1255566634
Name:PUTTAGUNTA, LAVANYA (DMD)
Entity type:Individual
Prefix:DR
First Name:LAVANYA
Middle Name:
Last Name:PUTTAGUNTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 WILLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5809
Mailing Address - Country:US
Mailing Address - Phone:240-491-1521
Mailing Address - Fax:
Practice Address - Street 1:1205 W MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6305
Practice Address - Country:US
Practice Address - Phone:214-778-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143671223G0001X
TX261071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice