Provider Demographics
NPI:1265134324
Name:BANDALAPALLE, KARTHIKA
Entity type:Individual
Prefix:
First Name:KARTHIKA
Middle Name:
Last Name:BANDALAPALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 FOLK VICTORIAN
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3489
Mailing Address - Country:US
Mailing Address - Phone:904-575-7027
Mailing Address - Fax:
Practice Address - Street 1:1606 FOLK VICTORIAN
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-3489
Practice Address - Country:US
Practice Address - Phone:904-575-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399471223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice