Individual
MANOGNA DEEPTHI YAKASIRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2001 E BROADWAY, LOGANSPORT, IN 46947-2048
(574) 232-9501
Mailing address
7 WARWICK LN, MOUNT VERNON, IL 62864-2344
(270) 972-9332
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019032341
IL
1223G0001X
General Practice Dentistry
Primary
12014048A
IN
Other
Enumeration date
08/15/2019
Last updated
05/06/2026
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