Provider Demographics
NPI:1659140150
Name:JONNALAGADDA, VENKATA NAGA SRAVANT (DDS)
Entity Type:Individual
Prefix:
First Name:VENKATA NAGA SRAVANT
Middle Name:
Last Name:JONNALAGADDA
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 1:2200 N URSULA ST APT 344
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7609
Mailing Address - Country:US
Mailing Address - Phone:203-550-5491
Mailing Address - Fax:
Practice Address - Street 1:2223 S MONACO ST PKWY, #F
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-824-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002058321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice