Provider Demographics
NPI:1578757019
Name:KODALI, HARITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARITA
Middle Name:
Last Name:KODALI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E WESTCHESTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2846
Mailing Address - Country:US
Mailing Address - Phone:972-546-3888
Mailing Address - Fax:469-619-0665
Practice Address - Street 1:355 E WESTCHESTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2846
Practice Address - Country:US
Practice Address - Phone:972-546-3888
Practice Address - Fax:469-619-0665
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice