Provider Demographics
NPI:1316406416
Name:VEERABHADRA PLLC
Entity Type:Organization
Organization Name:VEERABHADRA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYATHRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-358-0909
Mailing Address - Street 1:1600 BEDFORD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5702
Mailing Address - Country:US
Mailing Address - Phone:817-358-0909
Mailing Address - Fax:
Practice Address - Street 1:1600 BEDFORD RD STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5702
Practice Address - Country:US
Practice Address - Phone:817-358-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1417241209OtherNPPES