Provider Demographics
NPI:1508317132
Name:GUTLA PALLI, NARENDRA JAYANTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:JAYANTH
Last Name:GUTLA PALLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WOODVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8423
Mailing Address - Country:US
Mailing Address - Phone:617-817-4589
Mailing Address - Fax:
Practice Address - Street 1:17 LOWES DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NH
Practice Address - Zip Code:03276-5165
Practice Address - Country:US
Practice Address - Phone:603-729-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist