| NPI | 1619648342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NISHANTH REDDY PUCHALAPALLI Managing Member 408-306-8365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-22 |