Provider Demographics
NPI:1679252407
Name:DHARMALA, DEVIKA REDDY
Entity Type:Individual
Prefix:
First Name:DEVIKA
Middle Name:REDDY
Last Name:DHARMALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 VALLEY RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2159
Mailing Address - Country:US
Mailing Address - Phone:541-505-3185
Mailing Address - Fax:
Practice Address - Street 1:1055 VALLEY RIVER WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2159
Practice Address - Country:US
Practice Address - Phone:541-505-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist