Provider Demographics
NPI:1174405047
Name:MALLEMPALLI, PRATHIMA (DDS)
Entity type:Individual
Prefix:
First Name:PRATHIMA
Middle Name:
Last Name:MALLEMPALLI
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 1:177 TANGERINE DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3685
Mailing Address - Country:US
Mailing Address - Phone:650-250-9375
Mailing Address - Fax:
Practice Address - Street 1:15550 S I-35 FRONTAGE RD
Practice Address - Street 2:STE 110
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610
Practice Address - Country:US
Practice Address - Phone:512-265-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice