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General NPI Number Information
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NPI Number | 1588410005
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Entity Type | Organization
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Legal Business Name | ELMWOOD DENTAL PC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 1132 NEW BRITAIN AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06110-2413
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Country | US
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Telephone | 833-432-1457
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 NEW BRITAIN AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06110-2413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. NAYAKI GADDIPATI
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Credential | DMD
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Telephone | 214-336-9767
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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 |
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License Number State |
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