Provider Demographics
NPI:1881478774
Name:PUTCHALA, LAVANYA SIREESHA (DDS)
Entity type:Individual
Prefix:
First Name:LAVANYA SIREESHA
Middle Name:
Last Name:PUTCHALA
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 1:2318 CAMPBELL COVE CT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-9638
Mailing Address - Country:US
Mailing Address - Phone:980-525-2869
Mailing Address - Fax:
Practice Address - Street 1:1432 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3902
Practice Address - Country:US
Practice Address - Phone:704-276-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC135161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program