Individual
DR. DIVIJA TAKKALAPELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
989 ELLIS AVE, JACKSON, MS 39209-6256
(769) 235-3019
Mailing address
989 ELLIS AVE, JACKSON, MS 39209-6256
(210) 867-6961
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
4488-24
MS
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
7626
LA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
OR-6079-25
MS
Other
Enumeration date
11/01/2024
Last updated
01/23/2025
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