Healthcare Provider Details

I. General information

NPI: 1174768931
Provider Name (Legal Business Name): PADMAJA KROTHAPALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE ST
PORTLAND ME
04103-2617
US

IV. Provider business mailing address

25 NASHUA RD UNIT D1
LONDONDERRY NH
03053-3446
US

V. Phone/Fax

Practice location:
  • Phone: 207-221-4700
  • Fax:
Mailing address:
  • Phone: 617-432-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDEN5297
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number04176
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDL10511
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: