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General NPI Number Information
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NPI Number | 1114178795
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Entity Type | Organization
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Legal Business Name | RAVI C MADDALI, DDS, PC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 639 W 173RD ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10032-1426
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Country | US
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Telephone | 212-928-4480
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Fax | 212-928-8389
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Provider Business Mailing Address
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Address Line | 639 W 173RD ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10032-1426
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Country | US
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Telephone | 212-928-4480
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Fax | 212-928-8389
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAVI C MADDALI
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Credential | DDS
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Telephone | 212-928-4480
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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 | 051162-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 034679-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 045922-1
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License Number State | NY
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