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General NPI Number Information
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NPI Number | 1457523052
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Entity Type | Organization
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Legal Business Name | LAKSHMI P. THALANKI, DMD,MS,PC
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 118 FOREST AVE SUITE 202
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City | HUDSON
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State | MA
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Zip | 01749-2858
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Country | US
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Telephone | 978-562-1234
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Fax | 978-562-3310
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Provider Business Mailing Address
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Address Line | 118 FOREST AVE, SUITE 202
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City | HUDSON
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State | MA
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Zip | 01749
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Country | US
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Telephone | 978-562-1234
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Fax | 978-562-3310
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAKSHMI P THALANKI
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Credential | DMD, MS
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Telephone | 978-562-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 19674
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License Number State | MA
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