NPIMap

Organization Active NPI

Prasad Gonavarum D.D.S., Professional Corporation

  • Dental Clinic/Center
  • La Mesa, CA
National Provider Identifier
1124689302
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PRASAD GONAVARUM D.D.S., PROFESSIONAL CORPORATION
Practice address
7122 University Ave
La Mesa, CA 91942-5926
Phone
(619) 698-5471
NPI assigned
Jun 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Prasad Gonavarum, DDSNPI 1174512339
Title
President/Owner
Phone
(630) 788-5833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

7122 University Ave
La Mesa, CA 91942-5926

Mailing address

7122 University Ave
La Mesa, CA 91942-5926
Phone (619) 698-5471

Other names 1

  • Smiles of La Mesa Doing business as

National Provider Directory

National Provider Directory

Locations

7122 University Ave
La Mesa, CA 91942
Phone (619) 698-5471

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1124689302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7122 UNIVERSITY AVE",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425926",
            "telephone_number": "619-698-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7122 UNIVERSITY AVE",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425926",
            "telephone_number": "619-698-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRASAD GONAVARUM D.D.S., PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-27",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "GONAVARUM",
        "authorized_official_first_name": "PRASAD",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-788-5833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles of La Mesa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.