Provider Demographics
NPI:1174202667
Name:YAKKALI, VEERA VENKATA M N M (DDS)
Entity type:Individual
Prefix:DR
First Name:VEERA VENKATA M N M
Middle Name:
Last Name:YAKKALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MADHURI
Other - Middle Name:
Other - Last Name:YAKKALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:17717 36TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7570
Mailing Address - Country:US
Mailing Address - Phone:510-556-7500
Mailing Address - Fax:
Practice Address - Street 1:17717 36TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7570
Practice Address - Country:US
Practice Address - Phone:510-556-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61446085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist