Individual provider Active NPI

Lavanya Inampudi, D.M.D

  • General Practice Dentistry
  • Dallas, TX
National Provider Identifier
1710041868
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22252 Issued in TX
Practice address
655 West Illinois Avenue
Suite # 1065
Dallas, TX 75224
Phone
(214) 943-2484
NPI assigned
Dec 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22252 TX Primary

Addresses

Primary practice location

655 West Illinois Avenue
Suite # 1065
Dallas, TX 75224

Mailing address

655 West Illinois Ave #1065
Dallas, TX 75224
Phone (214) 943-2484

Other identifiers 1

IdentifierTypeStateIssuer
173286902MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20150708000452 TX Order and Referring Only - DentistPractitioner - Dentist 5799097564

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22252TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Citi Dental PLLC General Practice Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1710041868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 WEST ILLINOIS AVE #1065",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75224",
            "telephone_number": "214-943-2484",
            "fax_number": "214-975-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 WEST ILLINOIS AVENUE",
            "address_2": "SUITE # 1065",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75224",
            "telephone_number": "214-943-2484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INAMPUDI",
        "first_name": "LAVANYA",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173286902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.