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General NPI Number Information
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NPI Number | 1053048223
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Entity Type | Individual
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Provider Name | SAI PAVAN ADIGARLA DDS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2022
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 5107 COLLEGE AVE STE 2
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City | SNYDER
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State | TX
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Zip | 79549-6277
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Country | US
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Telephone | 325-574-1512
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 37TH ST APT 1001
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City | SNYDER
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State | TX
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Zip | 79549-4833
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Country | US
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Telephone | 270-996-5692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38866
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License Number State | TX
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