Provider Demographics
NPI:1275805129
Name:KATRAGUNTA, RADHIKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:KATRAGUNTA
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 1:2050 E ALGONQUIN RD
Mailing Address - Street 2:610
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4144
Mailing Address - Country:US
Mailing Address - Phone:888-988-4066
Mailing Address - Fax:847-496-7202
Practice Address - Street 1:1365 BARROW ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5171
Practice Address - Country:US
Practice Address - Phone:888-988-4066
Practice Address - Fax:847-496-7202
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276951223G0001X
GADN0153601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice