MEDICARE: DR. VENKATA SIVA PRASAD BANDI D.M.D

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	1223G0001X	General Practice Dentistry	29500	TX

General Provider Information

NPI Number	:	1548699978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA SIVA PRASAD BANDI D.M.D

Provider Business Mailing Address
First Line	:	1225 TOWN CENTER DR
Second Line	:	APT 2148
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-7856
Country	:	US
Telephone Number	:	512-920-7949
Fax Number	:

Provider Business Practice Location Address
First Line	:	7062 LAWNDALE ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-4210
Country	:	US
Telephone Number	:	713-923-4333
Fax Number	:	713-565-3665

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

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	04/23/2024

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