Provider Demographics
NPI:1568198117
Name:DR. PRATIBHA VEGULLA DDS
Entity Type:Organization
Organization Name:DR. PRATIBHA VEGULLA DDS
Other - Org Name:LOTUS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-348-2993
Mailing Address - Street 1:133 ARCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1326
Mailing Address - Country:US
Mailing Address - Phone:650-299-9990
Mailing Address - Fax:
Practice Address - Street 1:133 ARCH ST STE 4
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1326
Practice Address - Country:US
Practice Address - Phone:650-299-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty