Provider Demographics
NPI:1730614157
Name:NANNAPANENI, LAKSHMI PRATHYUSHA (DDS)
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:PRATHYUSHA
Last Name:NANNAPANENI
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 1:6090 PHEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6982
Mailing Address - Country:US
Mailing Address - Phone:513-926-9797
Mailing Address - Fax:
Practice Address - Street 1:3781 S NOVA RD STE B
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4285
Practice Address - Country:US
Practice Address - Phone:386-788-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02666200122300000X
FLDN24565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist