DR. Gangadhar Immanni, DDS
NPI #1912285032 in Portales, New Mexico
Provider Information
- NPI Number
- 1912285032
- Entity Type
- Individual
- Name
- DR. Gangadhar Immanni, DDS
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Dentist - General Practice
- Credential
- DDS
- Enumeration Date
- Jul 22, 2011
- Last Updated
- Nov 13, 2012
Practice Location
- Address
- 1515 WEST FIR
- City
- Portales
- State
- New Mexico
- ZIP Code
- 88130
- Phone
- (575) 356-6695
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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