MEDICARE: DR. SMITHA CHOWDARY MALINENI DDS

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	122300000X	Dentist	019027015	IL
2	122300000X	Dentist	12011551A	IN

General Provider Information

NPI Number	:	1649412453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SMITHA CHOWDARY MALINENI DDS

Provider Business Mailing Address
First Line	:	10703 CLUB CHASE
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-9435
Country	:	US
Telephone Number	:	312-505-7514
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 W MARKET ST
Second Line	:	#270
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2801
Country	:	US
Telephone Number	:	312-505-7514
Fax Number	:

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

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	11/29/2011

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