MEDICARE: DR. DURGA V DEVARAKONDA D.M.D

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	30832	TX

General Provider Information

NPI Number	:	1477837441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DURGA V DEVARAKONDA D.M.D

Provider Business Mailing Address
First Line	:	1111 W FRANKFORD RD
Second Line	:	SUITE 101
City	:	CARROLLTON
State	:	TX
Zip	:	75007-4944
Country	:	US
Telephone Number	:	972-245-3395
Fax Number	:	972-245-3953

Provider Business Practice Location Address
First Line	:	1111 W FRANKFORD RD
Second Line	:	SUITE 101
City	:	CARROLLTON
State	:	TX
Zip	:	75007-4944
Country	:	US
Telephone Number	:	972-245-3395
Fax Number	:	972-245-3953

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	07/20/2015

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