Provider Demographics
NPI:1013190172
Name:PARVATHI POKALA DDS INCORPORATED
Entity Type:Organization
Organization Name:PARVATHI POKALA DDS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVATHI
Authorized Official - Middle Name:KOKA
Authorized Official - Last Name:POKALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-274-0722
Mailing Address - Street 1:3737 MORAGA AVE STE B313
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5481
Mailing Address - Country:US
Mailing Address - Phone:858-274-0722
Mailing Address - Fax:858-274-1175
Practice Address - Street 1:3737 MORAGA AVE STE B313
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5481
Practice Address - Country:US
Practice Address - Phone:858-274-0722
Practice Address - Fax:858-274-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92041-01OtherDENTICAL IDENTIFICATION