=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154094183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JYOTHI LAKSHMI ANAND DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2021
-----------------------------------------------------
Last Update Date | 07/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4654 HIGHWAY 6 N STE 401
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-2880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-509-9194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4654 HIGHWAY 6 N STE 401
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-2880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-509-9194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 37334
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------