Provider Demographics
NPI:1720828338
Name:MADHAVI DURVASULA DDS INC
Entity type:Organization
Organization Name:MADHAVI DURVASULA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DURVASULA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-930-2634
Mailing Address - Street 1:5460 SUNOL BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7752
Mailing Address - Country:US
Mailing Address - Phone:408-930-2634
Mailing Address - Fax:
Practice Address - Street 1:5460 SUNOL BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7752
Practice Address - Country:US
Practice Address - Phone:925-880-8400
Practice Address - Fax:925-430-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty