Provider Demographics
NPI:1174768931
Name:KROTHAPALLI, PADMAJA
Entity type:Individual
Prefix:
First Name:PADMAJA
Middle Name:
Last Name:KROTHAPALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NASHUA RD
Mailing Address - Street 2:UNIT D1
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3446
Mailing Address - Country:US
Mailing Address - Phone:617-432-6430
Mailing Address - Fax:
Practice Address - Street 1:25 NASHUA RD
Practice Address - Street 2:UNIT D1
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3446
Practice Address - Country:US
Practice Address - Phone:617-432-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL105111223P0300X
NH04176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist