Provider Demographics
NPI:1649824632
Name:GOLLAPUDI, YAMINI MANI CHANDANA (DDS)
Entity type:Individual
Prefix:
First Name:YAMINI
Middle Name:MANI CHANDANA
Last Name:GOLLAPUDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:Y M CHANDANA
Other - Middle Name:
Other - Last Name:GOLLAPUDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1233 SIOUX ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-3314
Mailing Address - Country:US
Mailing Address - Phone:678-756-7191
Mailing Address - Fax:
Practice Address - Street 1:1233 SIOUX ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-3314
Practice Address - Country:US
Practice Address - Phone:678-756-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist