Provider Demographics
NPI:1710756374
Name:DUGGIRALA, VANDANA (DDS, BDS)
Entity Type:Individual
Prefix:
First Name:VANDANA
Middle Name:
Last Name:DUGGIRALA
Suffix:
Gender:F
Credentials:DDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7292 S BLACKHAWK ST # 2-104
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4109
Mailing Address - Country:US
Mailing Address - Phone:412-537-8033
Mailing Address - Fax:
Practice Address - Street 1:501 W HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2109
Practice Address - Country:US
Practice Address - Phone:303-942-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002058301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice