Provider Demographics
NPI:1750701058
Name:DIVYA VENKATARAMAN DMD PLLC
Entity type:Organization
Organization Name:DIVYA VENKATARAMAN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:940-691-5027
Mailing Address - Street 1:1 EUREKA CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2929
Mailing Address - Country:US
Mailing Address - Phone:940-691-5027
Mailing Address - Fax:
Practice Address - Street 1:1 EUREKA CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2929
Practice Address - Country:US
Practice Address - Phone:940-691-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty