Individual
PRASIDA MANDAPATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
16810 MERIDIAN AVE E STE J107, PUYALLUP, WA 98375
(253) 848-7777
Mailing address
25615 ELLIS RIDGE CT, KATY, TX 77494-6046
(281) 450-6353
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
37815
TX
122300000X
Dentist
Primary
DE61387262
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37815
—
TX
Enumeration date
09/14/2021
Last updated
03/09/2023
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