Provider Demographics
NPI:1306909080
Name:GONDI, MAHESH BABU (DMD)
Entity type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:BABU
Last Name:GONDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 CYNTHIA LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-8510
Mailing Address - Country:US
Mailing Address - Phone:972-750-0610
Mailing Address - Fax:
Practice Address - Street 1:1560 E CANTON RD STE G
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-2995
Practice Address - Country:US
Practice Address - Phone:956-415-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics