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General NPI Number Information
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NPI Number | 1730614157
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Entity Type | Individual
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Provider Name | LAKSHMI PRATHYUSHA NANNAPANENI DDS
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Gender | Female
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Dates
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Enumeration Date | 04/23/2017
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 3781 S NOVA RD STE B
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City | PORT ORANGE
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State | FL
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Zip | 32129-4285
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Country | US
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Telephone | 386-788-8388
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Fax |
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Provider Business Mailing Address
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Address Line | 6090 PHEASANT RIDGE DR
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City | PORT ORANGE
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State | FL
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Zip | 32128-6982
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Country | US
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Telephone | 513-926-9797
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02666200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN24565
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License Number State | FL
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