Healthcare Provider Details

I. General information

NPI: 1679950851
Provider Name (Legal Business Name): LAXMI SAI DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S COTTONWOOD DRIVE SUITE B
RICHARDSON TX
75080
US

IV. Provider business mailing address

300 S COTTONWOOD DR SUITE-B
RICHARDSON TX
75080-5751
US

V. Phone/Fax

Practice location:
  • Phone: 214-307-4755
  • Fax:
Mailing address:
  • Phone: 214-307-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22213
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24942
License Number StateTX

VIII. Authorized Official

Name: DR. MAHESH GONDI
Title or Position: MANAGING DIRECTOR
Credential: D.M.D.
Phone: 214-307-4755