Provider Demographics
NPI:1962950964
Name:YADLAPATI, MAMATHA (BDS, MSD)
Entity type:Individual
Prefix:
First Name:MAMATHA
Middle Name:
Last Name:YADLAPATI
Suffix:
Gender:F
Credentials:BDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 BARTRUM TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5694
Mailing Address - Country:US
Mailing Address - Phone:256-783-6635
Mailing Address - Fax:
Practice Address - Street 1:1711 BARTRUM TRL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5694
Practice Address - Country:US
Practice Address - Phone:256-783-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics