Provider Demographics
NPI:1679636526
Name:NAGARURU, KAVITHA (DMD)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:NAGARURU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2909
Mailing Address - Country:US
Mailing Address - Phone:972-548-9956
Mailing Address - Fax:972-692-8468
Practice Address - Street 1:1933 N CENTRAL EXPY
Practice Address - Street 2:SUITE 520
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2909
Practice Address - Country:US
Practice Address - Phone:972-548-9956
Practice Address - Fax:972-692-8468
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist