Provider Demographics
NPI:1083878755
Name:NADIMPALLI, PARVATHI (DMD)
Entity Type:Individual
Prefix:
First Name:PARVATHI
Middle Name:
Last Name:NADIMPALLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3516
Mailing Address - Country:US
Mailing Address - Phone:508-852-1805
Mailing Address - Fax:508-853-8593
Practice Address - Street 1:19 TACOMA ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3516
Practice Address - Country:US
Practice Address - Phone:508-852-1805
Practice Address - Fax:508-853-8593
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22223122300000X
MADN22223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301071OtherGROUP NUMBER
MA1310097Medicaid
MA1310097Medicaid