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General NPI Number Information
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NPI Number | 1023244589
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Entity Type | Organization
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Legal Business Name | DURAIAPPA DENTAL SERVICES PC
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 304 W LYON ST PO 448
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City | MARSHALL
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State | MN
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Zip | 56258-1308
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Country | US
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Telephone | 507-532-2233
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Fax | 507-532-2234
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Provider Business Mailing Address
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Address Line | 304 W LYON ST PO 448
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City | MARSHALL
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State | MN
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Zip | 56258-1308
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Country | US
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Telephone | 507-532-2233
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Fax | 507-532-2234
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Authorized Official
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Title or Position | OWNER
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Name | DR. VENKATRAMAN DURAIAPPA
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Credential | BDS
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Telephone | 507-532-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11917
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License Number State | MN
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