Individual
MS. VASANTHA LAKSHMI PEDARLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4955 S NATIONAL AVE UNIT A, SPRINGFIELD, MO 65810-2989
(417) 886-1010
Mailing address
10357 BOSWELL DR, FRISCO, TX 75035-2496
(816) 389-1213
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2025022117
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962188136
STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM
NY
Enumeration date
06/23/2023
Last updated
06/17/2025
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