Provider Demographics
NPI:1518332444
Name:HEALTHY DENTAL OF HYATTSVILLE, LLC
Entity Type:Organization
Organization Name:HEALTHY DENTAL OF HYATTSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADIMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPA
Authorized Official - Phone:201-257-7095
Mailing Address - Street 1:5570 SILVER HILL RD
Mailing Address - Street 2:PENN STATION SHOPPING CENTER
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1104
Mailing Address - Country:US
Mailing Address - Phone:301-202-2222
Mailing Address - Fax:
Practice Address - Street 1:3114 QUEENS CHAPEL RD
Practice Address - Street 2:THE SHOPS AT QUEENS CHILLUM
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3665
Practice Address - Country:US
Practice Address - Phone:301-338-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty