Provider Demographics
NPI:1831436328
Name:LATHA VOLADRI D.D.S,L.LC
Entity type:Organization
Organization Name:LATHA VOLADRI D.D.S,L.LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-815-0515
Mailing Address - Street 1:641 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4919
Mailing Address - Country:US
Mailing Address - Phone:973-815-0515
Mailing Address - Fax:973-916-0280
Practice Address - Street 1:641 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4919
Practice Address - Country:US
Practice Address - Phone:973-815-0515
Practice Address - Fax:973-916-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02295900261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental