Provider Demographics
NPI:1255665360
Name:PATMIDI, AVANTI REDDY (DDS)
Entity type:Individual
Prefix:DR
First Name:AVANTI
Middle Name:REDDY
Last Name:PATMIDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3005
Mailing Address - Country:US
Mailing Address - Phone:215-809-2324
Mailing Address - Fax:215-970-5552
Practice Address - Street 1:1234 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3005
Practice Address - Country:US
Practice Address - Phone:215-809-2324
Practice Address - Fax:215-809-2324
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice