Provider Demographics
NPI:1417223637
Name:NISHITA IRUKULLA LLC
Entity Type:Organization
Organization Name:NISHITA IRUKULLA LLC
Other - Org Name:NEW FALLS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRUKULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-759-0194
Mailing Address - Street 1:7419 NEW FALLS RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-1008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7419 NEW FALLS RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-1008
Practice Address - Country:US
Practice Address - Phone:215-945-5199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty