Provider Demographics
NPI:1639851959
Name:PADUBIDRI, POORNIMA RAO (DDS)
Entity Type:Individual
Prefix:
First Name:POORNIMA RAO
Middle Name:
Last Name:PADUBIDRI
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 1:24723 E APPLEWOOD DR APT 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4359
Mailing Address - Country:US
Mailing Address - Phone:510-203-8447
Mailing Address - Fax:
Practice Address - Street 1:24112 E ORCHARD RD UNIT F
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5349
Practice Address - Country:US
Practice Address - Phone:303-824-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002054701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice