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General NPI Number Information
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NPI Number | 1013190172
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Entity Type | Organization
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Legal Business Name | PARVATHI POKALA DDS INCORPORATED
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 3737 MORAGA AVE STE B313
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City | SAN DIEGO
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State | CA
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Zip | 92117-5481
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Country | US
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Telephone | 858-274-0722
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Fax | 858-274-1175
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Provider Business Mailing Address
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Address Line | 3737 MORAGA AVE STE B313
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City | SAN DIEGO
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State | CA
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Zip | 92117-5481
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Country | US
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Telephone | 858-274-0722
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Fax | 858-274-1175
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Authorized Official
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Title or Position | OWNER
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Name | DR. PARVATHI KOKA POKALA
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Credential | DDS
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Telephone | 858-274-0722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 40296
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License Number State | CA
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