Provider Demographics
NPI:1619223500
Name:GAJULA, TULASI S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TULASI
Middle Name:S
Last Name:GAJULA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5568
Mailing Address - Country:US
Mailing Address - Phone:575-769-0888
Mailing Address - Fax:575-763-9154
Practice Address - Street 1:1521 W 13TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5568
Practice Address - Country:US
Practice Address - Phone:575-769-0888
Practice Address - Fax:575-763-9154
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist