Provider Demographics
NPI:1154489771
Name:MADANAPALLI, POORNIMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:POORNIMA
Middle Name:
Last Name:MADANAPALLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MOORSLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3032
Mailing Address - Country:US
Mailing Address - Phone:917-698-6607
Mailing Address - Fax:
Practice Address - Street 1:319 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8101
Practice Address - Country:US
Practice Address - Phone:856-691-3300
Practice Address - Fax:856-794-7183
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02324000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist