Provider Demographics
NPI:1093480279
Name:KODAGANALLUR PITCHUMANI, PRIYANKA (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:KODAGANALLUR PITCHUMANI
Suffix:
Gender:F
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-8004
Mailing Address - Country:US
Mailing Address - Phone:319-467-0150
Mailing Address - Fax:
Practice Address - Street 1:801 NEWTON RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-8004
Practice Address - Country:US
Practice Address - Phone:319-467-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0043581223P0300X
IAFAC-402331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics