Provider Demographics
NPI:1669039244
Name:VATNIKA, TEDI
Entity type:Individual
Prefix:
First Name:TEDI
Middle Name:
Last Name:VATNIKA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 LIMESTONE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2005
Mailing Address - Country:US
Mailing Address - Phone:302-274-0130
Mailing Address - Fax:
Practice Address - Street 1:4420 LIMESTONE RD STE 208
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2005
Practice Address - Country:US
Practice Address - Phone:302-274-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042149122300000X, 1223E0200X
DEG1-00115811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist