1649412453 NPI number — DR. SMITHA CHOWDARY MALINENI DDS

Table of content: DR. SMITHA CHOWDARY MALINENI DDS (NPI 1649412453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649412453 NPI number — DR. SMITHA CHOWDARY MALINENI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALINENI
Provider First Name:
SMITHA
Provider Middle Name:
CHOWDARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KANCHERLA
Provider Other First Name:
SMITHA
Provider Other Middle Name:
CHOWDARY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649412453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10703 CLUB CHASE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46037-9435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-505-7514
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 W MARKET ST
Provider Second Line Business Practice Location Address:
#270
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46204-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-505-7514
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2009

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:  019027015 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 12011551A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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