Provider Demographics
NPI:1649589151
Name:KALA SAGAR MADUGULA DMD INC
Entity Type:Organization
Organization Name:KALA SAGAR MADUGULA DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MADUGULA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-652-3900
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:
Practice Address - Street 1:5700 YOUNGSTOWN WARREN RD
Practice Address - Street 2:UNIT 107
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4762
Practice Address - Country:US
Practice Address - Phone:330-652-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty