DR. GANGADHAR IMMANNI (NPI# 1912285032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912285032 |
| Entity Type | Individual |
| Full Name | DR. GANGADHAR IMMANNI |
| Credential | DDS |
| Practice Address |
1515 West Fir Portales NM 88130 |
| Mailing Address |
1515 West Fir Po Box 843 Portales NM 88130 |
| Practice Telephone | 5753566695 |
| Practice Fax Number | 5753565948 |
| Mailing Telephone | 5753566695 |
| Mailing Fax Number | 5753565948 |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2012-11-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DD3547 | NM | Dental Providers |
| Street Address |
1515 WEST FIR |
| City | PORTALES |
| State | NM |
| Zip Code | 88130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952392615 | Martha Slemp Thorsen | Nurse Practitioner | 1515 West Fir, Portales, NM 88130 | 2005-11-02 |
| 1225494800 | David Louis Womble | Nurse Practitioner | 1515 West Fir, Portales, NM 88130 | 2016-01-12 |
| 1407004583 | Jacqueline Acevedo Gonzalez | Internal Medicine | 1515 West Fir, Portales, NM 88130-0843 | 2008-09-03 |
| 1518114651 | Lindsay D Christensen | Dentist | 1515 West Fir, Portales, NM 88130 | 2008-08-20 |
| 1538150784 | James Franklin Smith | Dentist | 1515 West Fir, Portales, NM 88130 | 2005-11-04 |
| 1932190675 | Maxsimo C Torres | Family Medicine | 1515 West Fir, Portales, NM 88130 | 2005-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245861319 | Cynthia Alarid | Student in an Organized Health Care Education/Training Program | 1500 S Ave K Station 3, Schroc, Portales, NM 88130 | 2020-01-28 |
| 1649800384 | Gurveen Sandhu | Student in an Organized Health Care Education/Training Program | 1500 S Ave. K Station 3, Shroc, Portales, NM 88130 | 2020-01-22 |
| 1740744226 | Ashley Mcclelland | Student in an Organized Health Care Education/Training Program | 1500 S. Avenue K, Station 3 Shroc, Portales, NM 88130 | 2019-01-29 |
| 1285103218 | Jessica Dianne Terry | Behavior Technician | 743 S Hills Oak Rd, Portales, NM 88130 | 2018-11-20 |
| 1619445822 | Jonna Smith | Marriage & Family Therapist | 44 S Roosevelt Road N, Portales, NM 88130 | 2018-11-06 |
| 1932689254 | Carolina Yanez | Student in an Organized Health Care Education/Training Program | 1500 S. Avenue K Station 3 Shroc, Portales, NM 88130 | 2018-08-16 |
| 1033611918 | Shelley Marie Laya | Student in an Organized Health Care Education/Training Program | 1500 S. Ave K., Station 3, Shroc, Portales Nm, CA 88130 | 2018-03-06 |
| 1750800744 | Sara Rose Mccarty | Student in an Organized Health Care Education/Training Program | 1500 S Ave K Station 3, Shro, Portales, NM 88130 | 2017-09-12 |
| 1528584463 | Calli Bane | Student in an Organized Health Care Education/Training Program | 1500 South Ave. K, Station 3, Shroc, Portales, NM 88130 | 2017-08-22 |
| 1700302890 | Victoria L Young | Speech-Language Pathologist | 1500 South Ave K, Station 3 Shroc, Portales, NM 88130 | 2017-08-21 |
| Find all providers in zip 88130 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255444295 | Peter L Thompson | Dentist | 123 W 2nd St, Portales, NM 88130-6201 | 2006-08-16 |
| 1427570357 | Aaron Mark Standing | Dentist | 1521 W 18th St, Portales, NM 88130-7018 | 2017-07-12 |
| 1407280530 | Eastern Family Dentistry, LLC | Dentist | 1521 W 18th St, Portales, NM 88130-7018 | 2013-08-26 |
| 1043596406 | Dental Designs, PC | Dentist | 1521 W 18th St, Portales, NM 88130-7018 | 2011-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841803830 | Tri Dental, LLC | Dentist | 3715 Las Estancias Ct Sw Ste 101, Albuquerque, NM 87121-5506 | 2020-08-28 |
| 1609485077 | Joseph Potter | Dentist | 3510 Coors Blvd Sw, Albuquerque, NM 87121-5328 | 2020-07-30 |
| 1760090880 | Elizabeth Hays | Dentist | 1405 S Valley Dr Ste 300, Las Cruces, NM 88005-3132 | 2020-07-15 |
| 1861024861 | Brian K Dennis Dds PC | Dentist | 8400 Osuna Rd Ne Ste 6a, Albuquerque, NM 87111-2073 | 2020-02-07 |
| 1285264242 | Professional Dental Care Pllc | Dentist | 550 Saint Michaels Dr Ste 2, Santa Fe, NM 87505-7604 | 2020-01-18 |
| 1134769235 | Abq Dentists PC | Dentist | 3900 Eubank Blvd Ne Ste 14, Albuquerque, NM 87111-3427 | 2020-01-07 |
| 1477197804 | Juan Tabo Dentistry LLC | Dentist | 1924 Juan Tabo Blvd Ne Ste C, Albuquerque, NM 87112-3358 | 2019-10-29 |
| 1013550094 | Bosque Smiles Dentistry, LLC | Dentist | 5600 Coors Blvd Nw Ste G4, Albuquerque, NM 87120-1877 | 2019-10-23 |
| 1336796473 | Salud Dental Group Chaparral | Dentist | 320 Mccombs Rd Ste E, Chaparral, NM 88081-7937 | 2019-08-22 |
| 1639725732 | John Jerome Fagel | Dentist | 07 Choos Gai Dr, Tohatchi, NM 87325 | 2019-08-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.