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General NPI Number Information
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NPI Number | 1831436328
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Entity Type | Organization
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Legal Business Name | LATHA VOLADRI D.D.S,L.LC
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 641 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4919
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Country | US
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Telephone | 973-815-0515
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Fax | 973-916-0280
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Provider Business Mailing Address
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Address Line | 641 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4919
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Country | US
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Telephone | 973-815-0515
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Fax | 973-916-0280
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LATHA VOLADRI
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Credential | D.D.S
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Telephone | 973-815-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI02295900
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License Number State | NJ
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