Provider Demographics
NPI:1912331539
Name:RUDRAPATNA, LAVANYA (DMD)
Entity Type:Individual
Prefix:
First Name:LAVANYA
Middle Name:
Last Name:RUDRAPATNA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 WASKOM DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 E STACY RD STE 314
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8738
Practice Address - Country:US
Practice Address - Phone:214-563-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2022-04-14
Deactivation Date:2022-02-14
Deactivation Code:
Reactivation Date:2022-04-14
Provider Licenses
StateLicense IDTaxonomies
TX29283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist