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NPI Code Detail

MEDICARE: NISHITA IRUKULLA DDS

MEDICARE: NISHITA IRUKULLA 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
11223G0001XGeneral Practice Dentistry7625AZ
21223G0001XGeneral Practice DentistryDS037592PA
31223G0001XGeneral Practice Dentistry22DI02409100NJ

General Provider Information

NPI Number : 1578719829
Entity Type Code : Individual
Provider Name (Legal Business Name) : NISHITA IRUKULLA DDS
Provider Business Mailing Address
First Line : 9207 NEW FALLS RD
Second Line :
City : LANGHORNE
State : PA
Zip : 19047
Country : US
Telephone Number : 609-759-0194
Fax Number :
Provider Business Practice Location Address
First Line : 7419 NEW FALLS RD
Second Line :
City : LEVITTOWN
State : PA
Zip : 19055-1008
Country : US
Telephone Number : 215-945-5199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2008
Last Update Date : 04/05/2012

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