Provider Demographics
NPI:1003126137
Name:NADIMPALLI, MADHU VENKATA RAMA RAJU (DDS)
Entity type:Individual
Prefix:DR
First Name:MADHU VENKATA
Middle Name:RAMA RAJU
Last Name:NADIMPALLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 W SPRINGS DR
Mailing Address - Street 2:APT D
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3247
Mailing Address - Country:US
Mailing Address - Phone:201-257-7095
Mailing Address - Fax:
Practice Address - Street 1:5570 SILVER HILL RD
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1104
Practice Address - Country:US
Practice Address - Phone:301-202-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist