Provider Demographics
NPI:1952651473
Name:NAVUBOTHU, PADMALATHA
Entity Type:Individual
Prefix:
First Name:PADMALATHA
Middle Name:
Last Name:NAVUBOTHU
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 1:5393 KIMBERMERE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9301
Mailing Address - Country:US
Mailing Address - Phone:310-600-7688
Mailing Address - Fax:
Practice Address - Street 1:3824 MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1114
Practice Address - Country:US
Practice Address - Phone:804-767-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014137621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice