Provider Demographics
NPI:1184027021
Name:HEALTHY DENTAL LLC
Entity Type:Organization
Organization Name:HEALTHY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU VENKATA
Authorized Official - Middle Name:RAMA RAJU
Authorized Official - Last Name:NADIMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPA
Authorized Official - Phone:201-257-7095
Mailing Address - Street 1:3105 W SPRINGS DR
Mailing Address - Street 2:APT E
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-2940
Mailing Address - Country:US
Mailing Address - Phone:201-257-7095
Mailing Address - Fax:
Practice Address - Street 1:5570 SILVER HILL RD
Practice Address - Street 2:PENN STATION SHOPPING CENTRE
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1104
Practice Address - Country:US
Practice Address - Phone:301-202-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty