Provider Demographics
NPI:1821758137
Name:DIVIH, PLLC
Entity Type:Organization
Organization Name:DIVIH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SREERAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-231-8524
Mailing Address - Street 1:226 N CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226 N CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3141
Practice Address - Country:US
Practice Address - Phone:972-298-8515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty