Provider Demographics
NPI:1780743161
Name:NAGABANDI, PADMA SREE (DMD)
Entity type:Individual
Prefix:
First Name:PADMA
Middle Name:SREE
Last Name:NAGABANDI
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 1:7551 FOREST OAKS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-540-6800
Mailing Address - Fax:352-688-5031
Practice Address - Street 1:7551 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2437
Practice Address - Country:US
Practice Address - Phone:352-540-6800
Practice Address - Fax:352-688-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice