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General NPI Number Information
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NPI Number | 1811965114
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Entity Type | Individual
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Provider Name | PADMAJA K MUTYALA DDS
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 13029 STOCKDALE HWY SUITE 100
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City | BAKERSFIELD
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State | CA
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Zip | 93314-9589
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Country | US
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Telephone | 661-829-7905
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Fax |
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Provider Business Mailing Address
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Address Line | 11311 CRABBET PARK DR
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City | BAKERSFIELD
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State | CA
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Zip | 93311-9227
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Country | US
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Telephone | 661-663-9221
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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 | 54081
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License Number State | CA
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