Provider Demographics
NPI:1083153498
Name:HEALTHY DENTAL OF LANDOVER LLC
Entity Type:Organization
Organization Name:HEALTHY DENTAL OF LANDOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU VENKATA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NADIMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPA
Authorized Official - Phone:301-882-8888
Mailing Address - Street 1:3114 QUEENS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3665
Mailing Address - Country:US
Mailing Address - Phone:201-257-7095
Mailing Address - Fax:
Practice Address - Street 1:7023 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4016
Practice Address - Country:US
Practice Address - Phone:301-882-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty