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NPI Code Detail

MEDICARE: NISHITHA PONNAMANENI

MEDICARE: NISHITHA PONNAMANENI
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry38550TX

General Provider Information

NPI Number : 1881173201
Entity Type Code : Individual
Provider Name (Legal Business Name) : NISHITHA PONNAMANENI
Provider Business Mailing Address
First Line : 3030 LYNDON B JOHNSON FWY STE 1700
Second Line :
City : DALLAS
State : TX
Zip : 75234-2759
Country : US
Telephone Number : 972-444-8888
Fax Number :
Provider Business Practice Location Address
First Line : 3030 LBJ FWY STE 1700
Second Line :
City : DALLAS
State : TX
Zip : 75234-2759
Country : US
Telephone Number : 781-581-3900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2018
Last Update Date : 06/14/2022

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Directions to “ NISHITHA PONNAMANENI ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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