Prasida Mandapati, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE61387262 Issued in WA

Practice address

16810 Meridian Ave E Ste J107
Puyallup, WA 98375

Phone

(253) 848-7777

NPI assigned

Sep 14, 2021

Last updated

Mar 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Washington Dental Corporation PC

  dba Puyallup Smiles Dentistry

  • General Practice Dentistry
  • Puyallup, WA
  • NPI 1114324795
  NPD (past)
• Washington Dental Corporation, PC

  dba Puyallup Smiles Dentistry

  • General Practice Dentistry
  • Puyallup, WA
  • NPI 1417384348
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1295405025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25615 ELLIS RIDGE CT",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774946046",
            "telephone_number": "281-450-6353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16810 MERIDIAN AVE E STE J107",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "98375",
            "telephone_number": "253-848-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAPATI",
        "first_name": "PRASIDA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "37815",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61387262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37815",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Malone, OPTICIAN
• Peleese Mamoe, RPH
• Benita Sabina Flores Mana-Ay, M.ED
• Rajesh Manam, MD
• Thomas Manaois, DDS
• Bronson Mandeville
• Betty Ann Mann
• Ryann Michael Mann
• Colleen Manning, OTR/L
• Michael Manning

• Dentist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.