Individual
LAKSHMI PRATHYUSHA NANNAPANENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3781 S NOVA RD STE B, PORT ORANGE, FL 32129-4285
(386) 788-8388
Mailing address
6090 PHEASANT RIDGE DR, PORT ORANGE, FL 32128-6982
(513) 926-9797
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02666200
NJ
122300000X
Dentist
Primary
DN24565
FL
Other
Enumeration date
04/23/2017
Last updated
09/18/2019
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