Provider Demographics
NPI:1699555888
Name:MOTAPARTI, PHANISAI (DDS)
Entity type:Individual
Prefix:
First Name:PHANISAI
Middle Name:
Last Name:MOTAPARTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 ALISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3014
Mailing Address - Country:US
Mailing Address - Phone:669-230-9599
Mailing Address - Fax:
Practice Address - Street 1:1970 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3066
Practice Address - Country:US
Practice Address - Phone:831-888-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice