Geeta Gyaneshwari Mandavilli

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36840 Issued in TX

Practice address

3080 N Eastman Rd
Longview, TX 75605-5174

Phone

(903) 686-0086

NPI assigned

May 29, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636243200000",
    "number": "1811511470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 COUNTY ROAD 207 APT 1110",
            "city": "ALVARADO",
            "state": "TX",
            "postal_code": "760091450",
            "telephone_number": "334-488-9669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 N EASTMAN RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055174",
            "telephone_number": "903-686-0086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7251 Youree Dr",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055104",
            "country_code": "US",
            "telephone_number": "334-488-9669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANDAVILLI",
        "first_name": "GEETA",
        "middle_name": "GYANESHWARI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-29",
        "last_updated": "2021-11-07",
        "certification_date": "2021-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36840",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "7054-PR",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy J Malone, PA-C
• Diana Malone, MD
• David W Maly, CRNA
• Soumya Mamidi
• Edgar Ryan Mancilla
• Venkata Amarendra Mangalagiri, MD
• Audrey N Mangwiro, M.D.
• Suganya Manivannan, MD
• Jodie Manley, M.S., CCC-SLP
• Darvy Lee Mann, MD

• General Practice Dentistry in Longview, TX
• Providers in Longview, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.