Thirupathi Reddy Banda
Individual provider Active NPI Dentist · Madison, WI
NPI 1962074377 · NPPES record last updated Jul 14, 2021
Key facts
- NPI
- 1962074377
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1002645 (WI)
- Practice address
- 7866 Mineral Point Rd
Madison, WI 53717-2028 - Phone
- (608) 422-4746
- NPI assigned
- Jul 14, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 1002645 | WI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1002645 | WI | Yes |
Addresses
Primary practice location
7866 Mineral Point Rd
Madison, WI 53717-2028
Mailing address
7866 Mineral Point Rd
Madison, WI 53717-2028
Phone (608) 422-4746
Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2021. 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.