Organization
PRASAD GONAVARUM D.D.S., PROFESSIONAL CORPORATION
Active
Other names
Smiles of La Mesa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRASAD GONAVARUM DDS (PRESIDENT/OWNER)
(630) 788-5833
Entity
Organization
Contact information
Practice address
7122 UNIVERSITY AVE, LA MESA, CA 91942-5926
(619) 698-5471
Mailing address
7122 UNIVERSITY AVE, LA MESA, CA 91942-5926
(619) 698-5471
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/27/2019
Last updated
06/27/2019
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