Provider Demographics
NPI:1235205808
Name:NADIMPALLI, SUJATHA (DMD)
Entity Type:Individual
Prefix:
First Name:SUJATHA
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 1:1600 HORIZON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-4100
Mailing Address - Country:US
Mailing Address - Phone:267-247-5449
Mailing Address - Fax:267-247-5449
Practice Address - Street 1:1600 HORIZON DR STE 104
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-4100
Practice Address - Country:US
Practice Address - Phone:267-247-5449
Practice Address - Fax:267-247-5449
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-0358121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001975014Medicaid
PA001975014Medicaid