Provider Demographics
NPI:1104577071
Name:YEMBA, MADHULIKA (DDS)
Entity type:Individual
Prefix:
First Name:MADHULIKA
Middle Name:
Last Name:YEMBA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5708
Mailing Address - Country:US
Mailing Address - Phone:720-717-6012
Mailing Address - Fax:
Practice Address - Street 1:8702 S LANCASTER RD STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-6318
Practice Address - Country:US
Practice Address - Phone:720-717-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist