Provider Demographics
NPI:1700449725
Name:YALAMANCHILI, MAHESH (DDS)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:
Last Name:YALAMANCHILI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 GLENBARR CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3167
Mailing Address - Country:US
Mailing Address - Phone:703-593-6456
Mailing Address - Fax:
Practice Address - Street 1:12701 GALVESTON CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-8674
Practice Address - Country:US
Practice Address - Phone:973-926-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014168551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice