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General NPI Number Information
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NPI Number | 1306194451
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Entity Type | Individual
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Provider Name | VIJAYA LAKSHMI BATHINA DMD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 794 KELLER PKWY STE A
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City | KELLER
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State | TX
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Zip | 76248-2490
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Country | US
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Telephone | 817-431-1596
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Fax |
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Provider Business Mailing Address
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Address Line | 519 HIDDEN MEADOW DR
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City | KELLER
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State | TX
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Zip | 76248-1229
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Country | US
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Telephone | 806-420-9134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856099
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.029181
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29516
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License Number State | TX
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