MEDICARE: YAGNA ROOPA KASARANENI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12013829A	IN

General Provider Information

NPI Number	:	1326777814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAGNA ROOPA KASARANENI

Provider Business Mailing Address
First Line	:	13728 LEDGESTONE PL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-0057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4512 PARNELL AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5836
Country	:	US
Telephone Number	:	260-238-8899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	10/29/2022

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Directions to “ YAGNA ROOPA KASARANENI ” Practice Location

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