MEDICARE: DR. LALITA NEKKANTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		LA
2	1223G0001X	General Practice Dentistry	10506	TN

General Provider Information

NPI Number	:	1235525791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LALITA NEKKANTI

Provider Business Mailing Address
First Line	:	273 SEAVIEW AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-1716
Country	:	US
Telephone Number	:	201-723-1460
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 HUGHES CROSSING
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064
Country	:	US
Telephone Number	:	615-435-3274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2015
Last Update Date	:	07/21/2022

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