1659140150 NPI number — VENKATA NAGA SRAVANT JONNALAGADDA DDS

Table of content: VENKATA NAGA SRAVANT JONNALAGADDA DDS (NPI 1659140150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659140150 NPI number — VENKATA NAGA SRAVANT JONNALAGADDA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONNALAGADDA
Provider First Name:
VENKATA NAGA SRAVANT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659140150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2223 S MONACO ST PKWY
Provider Second Line Business Mailing Address:
#F
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80222-7609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-343-9358
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 S MONACO ST PKWY, #F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-824-4836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DEN.00205832 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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