Provider Demographics
NPI:1174681662
Name:MADALA, NIRMALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:
Last Name:MADALA
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 1:34278 TORREY PINE LN
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-8032
Mailing Address - Country:US
Mailing Address - Phone:510-887-5711
Mailing Address - Fax:
Practice Address - Street 1:123 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1809
Practice Address - Country:US
Practice Address - Phone:510-887-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist