Provider Demographics
NPI:1295514651
Name:GURU DATTA PLLC
Entity type:Organization
Organization Name:GURU DATTA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:848-391-6885
Mailing Address - Street 1:654 BANBURY RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2063
Mailing Address - Country:US
Mailing Address - Phone:848-391-6885
Mailing Address - Fax:
Practice Address - Street 1:6500 DENTON HWY STE B1
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2526
Practice Address - Country:US
Practice Address - Phone:817-428-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty