Provider Demographics
NPI:1609186147
Name:KATTA, MADHU (BDS, DMD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:
Last Name:KATTA
Suffix:
Gender:F
Credentials:BDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 BROUGHTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1822
Mailing Address - Country:US
Mailing Address - Phone:848-219-4517
Mailing Address - Fax:
Practice Address - Street 1:120 TEMPLE STREET
Practice Address - Street 2:AVALON DENTAL CENTER
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1910
Practice Address - Country:US
Practice Address - Phone:617-776-9000
Practice Address - Fax:617-776-9001
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855421122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice