Provider Demographics
NPI:1679278881
Name:BOMMISETTY, SRILAKSHMI
Entity type:Individual
Prefix:
First Name:SRILAKSHMI
Middle Name:
Last Name:BOMMISETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N MACARTHUR BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4868
Mailing Address - Country:US
Mailing Address - Phone:972-869-9090
Mailing Address - Fax:972-869-9090
Practice Address - Street 1:8300 N MACARTHUR BLVD STE 140
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4868
Practice Address - Country:US
Practice Address - Phone:972-869-9090
Practice Address - Fax:972-869-9090
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist