Provider Demographics
NPI:1528159456
Name:LALLA, ASHA PARVATHI (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:PARVATHI
Last Name:LALLA
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 1:3152 MINNEHAHA AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2774
Mailing Address - Country:US
Mailing Address - Phone:612-728-8888
Mailing Address - Fax:612-724-2737
Practice Address - Street 1:3152 MINNEHAHA AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2774
Practice Address - Country:US
Practice Address - Phone:612-728-8888
Practice Address - Fax:612-724-2737
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN712487200Medicaid