1457523052 NPI number — LAKSHMI P. THALANKI, DMD,MS,PC

Table of content: (NPI 1457523052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457523052 NPI number — LAKSHMI P. THALANKI, DMD,MS,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKSHMI P. THALANKI, DMD,MS,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1457523052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 FOREST AVE,
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-562-1234
Provider Business Mailing Address Fax Number:
978-562-3310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01749-2858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-562-1234
Provider Business Practice Location Address Fax Number:
978-562-3310
Provider Enumeration Date:
03/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
THALANKI
Authorized Official First Name:
LAKSHMI
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-562-1234

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  19674 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0296970 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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