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NPI Code Detail

MEDICARE: DR. PADMA DAGGULA

MEDICARE: DR. PADMA DAGGULA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry59728CA
21223P0221XPediatric Dentistry27427TX
31223G0001XGeneral Practice Dentistry27427TX

General Provider Information

NPI Number : 1275814212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PADMA DAGGULA
Provider Business Mailing Address
First Line : 2539 JUDSON RD
Second Line :
City : LONGVIEW
State : TX
Zip : 75605-4643
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2539 JUDSON RD
Second Line :
City : LONGVIEW
State : TX
Zip : 75605-4643
Country : US
Telephone Number : 903-553-1586
Fax Number : 903-234-8169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2011
Last Update Date : 09/26/2011

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Directions to “ DR. PADMA DAGGULA ” Practice Location

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