Provider Demographics
NPI:1023244589
Name:DURAIAPPA DENTAL SERVICES PC
Entity type:Organization
Organization Name:DURAIAPPA DENTAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATRAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAIAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:507-532-2233
Mailing Address - Street 1:304 W LYON ST
Mailing Address - Street 2:PO 448
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1308
Mailing Address - Country:US
Mailing Address - Phone:507-532-2233
Mailing Address - Fax:507-532-2234
Practice Address - Street 1:304 W LYON ST
Practice Address - Street 2:PO 448
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1308
Practice Address - Country:US
Practice Address - Phone:507-532-2233
Practice Address - Fax:507-532-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty