Provider Demographics
NPI:1477837441
Name:DEVARAKONDA, DURGA V (DMD)
Entity Type:Individual
Prefix:DR
First Name:DURGA
Middle Name:V
Last Name:DEVARAKONDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VENKATA
Other - Middle Name:DURGA
Other - Last Name:VARANASI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1111 W FRANKFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-4944
Mailing Address - Country:US
Mailing Address - Phone:972-245-3395
Mailing Address - Fax:972-245-3953
Practice Address - Street 1:1111 W FRANKFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-4944
Practice Address - Country:US
Practice Address - Phone:972-245-3395
Practice Address - Fax:972-245-3953
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308321223G0001X
MADN18557091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice