Provider Demographics
NPI:1871803684
Name:CITI DENTAL PLLC
Entity type:Organization
Organization Name:CITI DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:INAMPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:214-317-1120
Mailing Address - Street 1:5729 LEBANON RD
Mailing Address - Street 2:SUITE 144-151
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 WEST ILLINOIS AVE
Practice Address - Street 2:SUITE #1065
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-943-2484
Practice Address - Fax:214-975-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty