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General NPI Number Information
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NPI Number | 1750701058
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Entity Type | Organization
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Legal Business Name | DIVYA VENKATARAMAN DMD PLLC
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1 EUREKA CIR SUITE 103
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2929
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Country | US
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Telephone | 940-691-5027
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EUREKA CIR SUITE 103
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2929
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Country | US
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Telephone | 940-691-5027
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DIVYA IYER
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Credential | DMD
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Telephone | 940-691-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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