Provider Demographics
NPI:1972817203
Name:VADDINENI, ANURADHA (DMD)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:VADDINENI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANURADHA
Other - Middle Name:
Other - Last Name:VALLABHANENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6305 PRECINCT LINE ROAD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180
Mailing Address - Country:US
Mailing Address - Phone:817-663-0076
Mailing Address - Fax:817-663-0081
Practice Address - Street 1:6305 PRECINCT LINE ROAD
Practice Address - Street 2:SUITE #400
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-663-0076
Practice Address - Fax:817-663-0081
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128601223G0001X
TX278861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice