Deepthi Nambala, BDS

Primary specialty

DentistTaxonomy code 122300000X

License

R890 Issued in MN

Practice address

Special Healthcare Needs Dental Clinic
Malcolm Health Sciences Moos Tower, 515 Delaware St. SE
Minneapolis, MN 55455

Phone

(612) 625-4777

Fax

(612) 625-0613

NPI assigned

Oct 17, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1346061884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19839 IRIS WAY",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550443547",
            "telephone_number": "425-351-0826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SPECIAL HEALTHCARE NEEDS DENTAL CLINIC",
            "address_2": "MALCOLM HEALTH SCIENCES MOOS TOWER, 515 DELAWARE ST. SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-625-4777",
            "fax_number": "612-625-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAMBALA",
        "first_name": "DEEPTHI",
        "name_prefix": "Dr.",
        "credential": "BDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "R890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Kristin Najm, LADC
• Kevin Neil Nakagaki, DDS
• Yukiko Nakajima, NP
• Nissrine A Nakib, M.D.
• Nusifah Namakula
• Lavanya Namballa, MD
• Muwahib Muhudin Namhani
• Zadok Nampala
• Vivienne Namujuzi
• Nancy a Norling DDS PA

• Dentist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2024; 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.