Provider Demographics
NPI:1457523052
Name:LAKSHMI P. THALANKI, DMD,MS,PC
Entity Type:Organization
Organization Name:LAKSHMI P. THALANKI, DMD,MS,PC
Other - Org Name:FAMILY ORTHODONTICS OF HUDSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:P
Authorized Official - Last Name:THALANKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:978-562-1234
Mailing Address - Street 1:118 FOREST AVE,
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749
Mailing Address - Country:US
Mailing Address - Phone:978-562-1234
Mailing Address - Fax:978-562-3310
Practice Address - Street 1:118 FOREST AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2858
Practice Address - Country:US
Practice Address - Phone:978-562-1234
Practice Address - Fax:978-562-3310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKSHMI P. THALANKI, DMD,MS,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0296970Medicaid