Provider Demographics
NPI:1548699978
Name:BANDI, VENKATA SIVA PRASAD (DMD)
Entity type:Individual
Prefix:DR
First Name:VENKATA SIVA PRASAD
Middle Name:
Last Name:BANDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 TOWN CENTER DR
Mailing Address - Street 2:APT 2148
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7856
Mailing Address - Country:US
Mailing Address - Phone:512-920-7949
Mailing Address - Fax:
Practice Address - Street 1:7062 LAWNDALE ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-4210
Practice Address - Country:US
Practice Address - Phone:713-923-4333
Practice Address - Fax:713-565-3665
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice