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General NPI Number Information
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NPI Number | 1609186147
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Entity Type | Individual
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Provider Name | MADHU KATTA BDS, DMD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 120 TEMPLE STREET AVALON DENTAL CENTER
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City | SOMERVILLE
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State | MA
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Zip | 02145-1910
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Country | US
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Telephone | 617-776-9000
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Fax | 617-776-9001
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Provider Business Mailing Address
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Address Line | 311 BROUGHTON DRIVE
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City | BEVERLY
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State | MA
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Zip | 01915-1822
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Country | US
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Telephone | 848-219-4517
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1855421
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License Number State | MA
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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 | DN1855421
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License Number State | MA
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