1790792125 NPI number — DR. BINDU MADHAVI KOLLI D.M.D.

Table of content: DR. BINDU MADHAVI KOLLI D.M.D. (NPI 1790792125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790792125 NPI number — DR. BINDU MADHAVI KOLLI D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLLI
Provider First Name:
BINDU
Provider Middle Name:
MADHAVI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
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:
1790792125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 W FM 544
Provider Second Line Business Mailing Address:
126
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094-4572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-424-2273
Provider Business Mailing Address Fax Number:
972-424-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 W FM 544
Provider Second Line Business Practice Location Address:
126
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75094-4572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-424-2273
Provider Business Practice Location Address Fax Number:
972-424-2222
Provider Enumeration Date:
08/01/2006

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:  21085 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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