Healthcare Provider Details

I. General information

NPI: 1073374468
Provider Name (Legal Business Name): NAVANEETHA HANUMANTHAPPA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2897 W HIGHWAY 74
MONROE NC
28110-8434
US

IV. Provider business mailing address

15645 GREYTHORNE DR APT 108
CHARLOTTE NC
28277-4761
US

V. Phone/Fax

Practice location:
  • Phone: 980-497-0966
  • Fax:
Mailing address:
  • Phone: 980-253-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14396
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: