Provider Demographics
NPI:1831982248
Name:MAA COTULLA DENTAL
Entity type:Organization
Organization Name:MAA COTULLA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA RAJESH KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PASUPULETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-618-4215
Mailing Address - Street 1:649 LAS PALMAS BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014-3209
Mailing Address - Country:US
Mailing Address - Phone:661-618-4215
Mailing Address - Fax:
Practice Address - Street 1:649 LAS PALMAS BLVD STE 8
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-3209
Practice Address - Country:US
Practice Address - Phone:661-618-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental