Organization
SPARK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MADHU VENKATA RAMA RAJU NADIMPALLI DDS,MPA (GENERAL DENTIST/ OWNER)
(201) 257-7095
Entity
Organization
Contact information
Practice address
18077 GARLAND GROH BLVD, HAGERSTOWN, MD 21740-2064
(301) 888-8555
Mailing address
12233 HAYLAND FARM WAY, ELLICOTT CITY, MD 21042-6027
(201) 257-7095
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/22/2024
Last updated
05/22/2024
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