Provider Demographics
NPI:1386296606
Name:NALLAPARAJU, HARITHA (DMD)
Entity type:Individual
Prefix:DR
First Name:HARITHA
Middle Name:
Last Name:NALLAPARAJU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W TEMPLE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2187
Mailing Address - Country:US
Mailing Address - Phone:217-342-0211
Mailing Address - Fax:
Practice Address - Street 1:900 W TEMPLE AVE STE 208
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2187
Practice Address - Country:US
Practice Address - Phone:217-342-0211
Practice Address - Fax:217-342-0232
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0322801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice