Provider Demographics
NPI:1386321164
Name:MESINENI, KEERTHANA (DDS)
Entity type:Individual
Prefix:
First Name:KEERTHANA
Middle Name:
Last Name:MESINENI
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 1:1018 N CALDWELL ST APT 420
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-3678
Mailing Address - Country:US
Mailing Address - Phone:980-322-5011
Mailing Address - Fax:
Practice Address - Street 1:810 BRAYDEN PKWY APT 109
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-0198
Practice Address - Country:US
Practice Address - Phone:980-322-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty