NPIMap

Organization Active NPI

Praveena Permalla, DDS, Inc

  • General Practice Dentistry
  • Petaluma, CA
National Provider Identifier
1356654594
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
54953 Issued in CA
Legal business name
PRAVEENA PERMALLA, DDS, INC
Practice address
855 Lakeville St
Suite 101
Petaluma, CA 94952-7328
Phone
(707) 773-1234
NPI assigned
Jul 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

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

Authorized official

Name
Dr. Praveena Permalla, DDSNPI 1801955778
Title
President
Phone
(707) 773-1234

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 54953 CA Primary

Addresses

Primary practice location

855 Lakeville St
Suite 101
Petaluma, CA 94952-7328

Mailing address

855 Lakeville St
Suite 101
Petaluma, CA 94952-7328
Phone (707) 773-1234

Other names 1

  • Permalla Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

855 Lakeville St
Ste 101
Petaluma, CA 94952
Phone (707) 773-1234

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": "1279238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279238400000",
    "number": "1356654594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 LAKEVILLE ST",
            "address_2": "SUITE 101",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949527328",
            "telephone_number": "707-773-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 LAKEVILLE ST",
            "address_2": "SUITE 101",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949527328",
            "telephone_number": "707-773-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAVEENA PERMALLA, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-16",
        "last_updated": "2010-07-16",
        "status": "A",
        "authorized_official_last_name": "PERMALLA",
        "authorized_official_first_name": "PRAVEENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-773-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Permalla Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; 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.