Provider Demographics
NPI:1831762756
Name:KATTA, MADHURI (DDS)
Entity type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:KATTA
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 1:113 RIVER COVE LN
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-9133
Mailing Address - Country:US
Mailing Address - Phone:205-960-2458
Mailing Address - Fax:
Practice Address - Street 1:3875 CONLON WAY STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9607
Practice Address - Country:US
Practice Address - Phone:252-679-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice