Provider Demographics
NPI:1457607327
Name:MOVVA, PRADEEPA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEPA
Middle Name:
Last Name:MOVVA
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 1:47 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1084
Mailing Address - Country:US
Mailing Address - Phone:305-302-2828
Mailing Address - Fax:
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2216
Practice Address - Country:US
Practice Address - Phone:860-229-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice