Basic Information
| Provider Information | |||||||||
| NPI: | 1679636526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAGARURU | ||||||||
| FirstName: | KAVITHA | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1933 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750702909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725489956 | ||||||||
| FaxNumber: | 9726928468 | ||||||||
| Practice Location | |||||||||
| Address1: | 1933 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750702909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725489956 | ||||||||
| FaxNumber: | 9726928468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 27533 | TX | Y | Dental Providers | Dentist |
No ID Information.