Provider Demographics
NPI:1639135478
Name:BEEDU, PRIYADARSHINI (DDS)
Entity type:Individual
Prefix:
First Name:PRIYADARSHINI
Middle Name:
Last Name:BEEDU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 S PARK VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6942
Mailing Address - Country:US
Mailing Address - Phone:408-945-4333
Mailing Address - Fax:408-945-4336
Practice Address - Street 1:1119 S PARK VICTORIA DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6942
Practice Address - Country:US
Practice Address - Phone:408-945-4333
Practice Address - Fax:408-945-4336
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8087122300000X
CA599771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639135478Medicaid
NC899025GMedicaid