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General NPI Number Information
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NPI Number | 1780754804
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Entity Type | Individual
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Provider Name | PRASHANTHI BADDAM D.M.D
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6601 S. RURAL RD. SUITE 1
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City | TEMPE
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State | AZ
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Zip | 85283-3747
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Country | US
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Telephone | 480-730-1857
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Fax |
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Provider Business Mailing Address
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Address Line | 753 W HONEYSUCKLE DR
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City | CHANDLER
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State | AZ
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Zip | 85248-3841
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Country | US
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Telephone | 480-219-0025
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Fax | 480-219-0025
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D5545
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License Number State | AZ
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