Provider Demographics
NPI:1417557547
Name:NORTH DALLAS PEDIATRICS ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTH DALLAS PEDIATRICS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BODAVULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-563-2943
Mailing Address - Street 1:6448 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5943
Mailing Address - Country:US
Mailing Address - Phone:972-216-8500
Mailing Address - Fax:
Practice Address - Street 1:6448 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5943
Practice Address - Country:US
Practice Address - Phone:972-216-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty