Provider Demographics
NPI:1790792125
Name:KOLLI, BINDU MADHAVI (DMD)
Entity Type:Individual
Prefix:DR
First Name:BINDU
Middle Name:MADHAVI
Last Name:KOLLI
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 1:158 W FM 544
Mailing Address - Street 2:126
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4572
Mailing Address - Country:US
Mailing Address - Phone:972-424-2273
Mailing Address - Fax:972-424-2222
Practice Address - Street 1:158 W FM 544
Practice Address - Street 2:126
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4572
Practice Address - Country:US
Practice Address - Phone:972-424-2273
Practice Address - Fax:972-424-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice