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NPI Code Detail

MEDICARE: GEETA GYANESHWARI MANDAVILLI

MEDICARE: GEETA GYANESHWARI MANDAVILLI
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
11223G0001XGeneral Practice Dentistry36840TX
21223G0001XGeneral Practice Dentistry7054-PRLA

General Provider Information

NPI Number : 1811511470
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEETA GYANESHWARI MANDAVILLI
Provider Business Mailing Address
First Line : 301 COUNTY ROAD 207 APT 1110
Second Line :
City : ALVARADO
State : TX
Zip : 76009-1450
Country : US
Telephone Number : 334-488-9669
Fax Number :
Provider Business Practice Location Address
First Line : 3080 N EASTMAN RD
Second Line :
City : LONGVIEW
State : TX
Zip : 75605-5174
Country : US
Telephone Number : 903-686-0086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2020
Last Update Date : 11/07/2021

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Directions to “ GEETA GYANESHWARI MANDAVILLI ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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