MEDICARE: DR. NIRUPAMA YARENAHALLI DDS

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
1	1223G0001X	General Practice Dentistry	DS042425	PA

General Provider Information

NPI Number	:	1326695412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIRUPAMA YARENAHALLI DDS

Provider Business Mailing Address
First Line	:	1728 RASPBERRY CT
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2748
Country	:	US
Telephone Number	:	479-966-7871
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 CHESTER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1410
Country	:	US
Telephone Number	:	215-724-6666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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