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General NPI Number Information
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NPI Number | 1396113064
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Entity Type | Organization
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Legal Business Name | DIAMOND DENTAL LLC
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 274 S MAIN ST UNIT C9
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City | NEWTOWN
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State | CT
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Zip | 06470-6705
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Country | US
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Telephone | 203-403-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 274 S MAIN ST UNIT C9
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City | NEWTOWN
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State | CT
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Zip | 06470-6705
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Country | US
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Telephone | 203-403-2446
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Fax |
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Authorized Official
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Title or Position | MEMBER, OWNER
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Name | DR. RATNA VEDULLAPALLI
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Credential | D.D.S.
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Telephone | 908-930-1938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 010135
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License Number State | CT
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