Provider Demographics
NPI:1932338373
Name:YADDANAPUDI, LAKSHMI DEEPTHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:DEEPTHI
Last Name:YADDANAPUDI
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 1:430 W ERIE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6914
Mailing Address - Country:US
Mailing Address - Phone:920-838-1649
Mailing Address - Fax:
Practice Address - Street 1:3434 W ILLINOIS AVE
Practice Address - Street 2:BLDG 3, SUITE 307
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8796
Practice Address - Country:US
Practice Address - Phone:203-906-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice