Provider Demographics
NPI:1174538805
Name:DURAIAPPA, VENKATRAMAN (BDS)
Entity type:Individual
Prefix:DR
First Name:VENKATRAMAN
Middle Name:
Last Name:DURAIAPPA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1231
Mailing Address - Country:US
Mailing Address - Phone:562-225-3327
Mailing Address - Fax:
Practice Address - Street 1:2 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1344
Practice Address - Country:US
Practice Address - Phone:320-589-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice