Individual
DIVYA MADIRAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4413 WARD ST, NORTH RICHLAND HILLS, TX 76180-8044
(325) 603-8500
Mailing address
1919 7TH AVE S, BIRMINGHAM, AL 35233-2005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40713
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/05/2023
Last updated
06/21/2024
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