Individual
DR. NISHANTH REDDY PUCHALAPALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
701 N MAIN AVE, LOVINGTON, NM 88260-3417
(408) 306-8365
Mailing address
701 N MAIN AVE, LOVINGTON, NM 88260-3417
(408) 306-8365
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD 3837
NM
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DD 3837
NM
Other
Enumeration date
06/27/2012
Last updated
08/23/2016
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