Provider Demographics
NPI:1225265622
Name:BATTULA, KAVITHA (DM,D)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:BATTULA
Suffix:
Gender:F
Credentials:DM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 BRYN MAWR CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4805
Mailing Address - Country:US
Mailing Address - Phone:201-655-3736
Mailing Address - Fax:
Practice Address - Street 1:597 BRYN MAWR CT
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4805
Practice Address - Country:US
Practice Address - Phone:201-655-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice