Provider Demographics
NPI:1104053487
Name:NANDURI, MAHATHI (DDS)
Entity type:Individual
Prefix:DR
First Name:MAHATHI
Middle Name:
Last Name:NANDURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAHATHI
Other - Middle Name:
Other - Last Name:MADIRAJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12832 WILLIAMS MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2957
Mailing Address - Country:US
Mailing Address - Phone:571-296-8047
Mailing Address - Fax:
Practice Address - Street 1:12832 WILLIAMS MEADOW CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4759
Practice Address - Country:US
Practice Address - Phone:571-296-8047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118961223G0001X
CA559471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice