Provider Demographics
NPI:1679708333
Name:VENIGALLA, PRADEEP (DDS)
Entity type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:VENIGALLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 QUARRY STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1007
Mailing Address - Country:US
Mailing Address - Phone:508-679-8111
Mailing Address - Fax:508-837-6078
Practice Address - Street 1:387 QUARRY STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1007
Practice Address - Country:US
Practice Address - Phone:508-679-8111
Practice Address - Fax:508-837-6078
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist