Provider Demographics
NPI:1740014158
Name:YELISETTY, PADMA PRIYA (DDS)
Entity type:Individual
Prefix:DR
First Name:PADMA
Middle Name:PRIYA
Last Name:YELISETTY
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 1:108 SWEETEN GRASS HL
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1233
Mailing Address - Country:US
Mailing Address - Phone:480-262-0670
Mailing Address - Fax:
Practice Address - Street 1:4 MARKET ST STE 4202
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-5641
Practice Address - Country:US
Practice Address - Phone:480-262-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist