Individual
PRAMOD TADAKAMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
907 S 6TH ST, SPRINGFIELD, IL 62703-2401
(716) 548-3741
Mailing address
907 S 6TH ST, SPRINGFIELD, IL 62703-2401
(716) 548-3741
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.031274
IL
Other
Enumeration date
07/19/2017
Last updated
07/19/2017
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