Provider Demographics
NPI:1578029245
Name:DOOTHRAYA PLLC
Entity type:Organization
Organization Name:DOOTHRAYA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-285-0871
Mailing Address - Street 1:1050 N BELT LINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1771
Mailing Address - Country:US
Mailing Address - Phone:972-285-0871
Mailing Address - Fax:
Practice Address - Street 1:1050 N BELT LINE RD STE 102
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1771
Practice Address - Country:US
Practice Address - Phone:972-285-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952711681OtherNPI TYPE 1