Provider Demographics
NPI:1992134050
Name:YELAMANCHI DENTAL PLC
Entity type:Organization
Organization Name:YELAMANCHI DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YELAMANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-245-3047
Mailing Address - Street 1:13817 JEFFERSON PARK DR
Mailing Address - Street 2:APT 4212
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4789
Mailing Address - Country:US
Mailing Address - Phone:650-245-3047
Mailing Address - Fax:
Practice Address - Street 1:13817 JEFFERSON PARK DR
Practice Address - Street 2:APT 4212
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4789
Practice Address - Country:US
Practice Address - Phone:650-245-3047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014142301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty