Vijaya Lakshmi Bathina, DMD
Individual provider Active NPI General Practice Dentistry · Keller, TX
NPI 1306194451 · NPPES record last updated Jan 17, 2022
Key facts
- NPI
- 1306194451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 29516 (TX)
- Practice address
- 794 Keller Pkwy Ste a
Keller, TX 76248-2490 - Phone
- (817) 431-1596
- NPI assigned
- Aug 21, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029181 | IL | MD | General Practice Dentistry |
| DN1856099 | MA | MD | General Practice Dentistry |
| 29516 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN1856099 | MA | |
| General Practice Dentistry | 1223G0001X | 019.029181 | IL | |
| General Practice Dentistry | 1223G0001X | 29516 | TX | Yes |
Addresses
Primary practice location
794 Keller Pkwy Ste a
Keller, TX 76248-2490
Mailing address
519 Hidden Meadow Dr
Keller, TX 76248-1229
Phone (806) 420-9134
Other providers in Keller, TX
- Linda Kay Barnes
- Paula M Baron
- Kelsey Barrett
- Jeanne Bass
- Dustin Bassow
- Malina Lynn Bauer
- Jessfor G Baugh
- Julie Baughman
- Baylor Regional Medical Center at Grapevine
- Bear Creek Pharmacy LLC
All providers in Keller, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.