1437592516 NPI number — DR. RAMA KRISHNA YELISETTY DMD

Table of content: DR. RAMA KRISHNA YELISETTY DMD (NPI 1437592516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437592516 NPI number — DR. RAMA KRISHNA YELISETTY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YELISETTY
Provider First Name:
RAMA
Provider Middle Name:
KRISHNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437592516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
368 HARBISON BLVD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29212-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-234-2320
Provider Business Mailing Address Fax Number:
803-781-5219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
368 HARBISON BLVD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29212-2248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-234-2320
Provider Business Practice Location Address Fax Number:
803-781-5219
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DGD.8185 GD , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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