Provider Demographics
NPI:1780918474
Name:KATRAGADDA, ASHA J (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:J
Last Name:KATRAGADDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 W PENN AVE
Mailing Address - Street 2:STE # 3
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-9702
Mailing Address - Country:US
Mailing Address - Phone:610-589-6084
Mailing Address - Fax:
Practice Address - Street 1:1192 W PENN AVE
Practice Address - Street 2:STE # 3
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9702
Practice Address - Country:US
Practice Address - Phone:610-589-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10107122300000X
PADS037824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist