Provider Demographics
NPI:1972012417
Name:YADAV, INDU BALA (DMD)
Entity Type:Individual
Prefix:DR
First Name:INDU
Middle Name:BALA
Last Name:YADAV
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 1:6A MANSION WOODS DR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2364
Mailing Address - Country:US
Mailing Address - Phone:720-238-6407
Mailing Address - Fax:
Practice Address - Street 1:1795 MAIN ST STE 215
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1015
Practice Address - Country:US
Practice Address - Phone:720-238-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist