Provider Demographics
NPI:1336339290
Name:GADDIPATI, NAYAKI (DMD)
Entity Type:Individual
Prefix:
First Name:NAYAKI
Middle Name:
Last Name:GADDIPATI
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 1:1200 PARK ST
Mailing Address - Street 2:#C
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2259
Mailing Address - Country:US
Mailing Address - Phone:214-336-9767
Mailing Address - Fax:214-336-9767
Practice Address - Street 1:1200 PARK ST
Practice Address - Street 2:#C
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2259
Practice Address - Country:US
Practice Address - Phone:214-336-9767
Practice Address - Fax:214-336-9767
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21848122300000X
CT0103971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist