Healthcare Provider Details

I. General information

NPI: 1801074489
Provider Name (Legal Business Name): PADMINI BYALALU KRISHNAMURTHY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 ANO NUEVO AVE 905
SUNNYVALE CA
94085-4177
US

IV. Provider business mailing address

395 ANO NUEVO AVE 905
SUNNYVALE CA
94085-4177
US

V. Phone/Fax

Practice location:
  • Phone: 408-245-8173
  • Fax:
Mailing address:
  • Phone: 408-245-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number56499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: