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General NPI Number Information
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NPI Number | 1689358996
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Entity Type | Individual
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Provider Name | SRUTHI KATAMNENI DDS
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | JEFFERSON DENTAL & ORTHODONTICS 4396 TOM LANDRY FWY, I-30
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City | DALLAS
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State | TX
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Zip | 75223
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Country | US
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Telephone | 214-451-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 7797 EDELWEISS TRL
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City | FRISCO
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State | TX
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Zip | 75034-0381
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Country | US
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Telephone | 681-888-3366
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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 | 39744
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License Number State | TX
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