Provider Demographics
NPI:1053595843
Name:BETTAGERE, VIDYA RAMESH (DDS, MSD)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:RAMESH
Last Name:BETTAGERE
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 LONG RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-2300
Mailing Address - Country:US
Mailing Address - Phone:260-668-0540
Mailing Address - Fax:
Practice Address - Street 1:3819 FAIRVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013
Practice Address - Country:US
Practice Address - Phone:765-622-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011084A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist