1912095928 NPI number — SUSMITHA ALURU DMD

Table of content: SUSMITHA ALURU DMD (NPI 1912095928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912095928 NPI number — SUSMITHA ALURU DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALURU
Provider First Name:
SUSMITHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912095928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 W FRONT ST
Provider Second Line Business Mailing Address:
SUITE#250
Provider Business Mailing Address City Name:
HUTTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78634-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-642-6109
Provider Business Mailing Address Fax Number:
512-642-6194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 W FRONT ST
Provider Second Line Business Practice Location Address:
SUITE#250
Provider Business Practice Location Address City Name:
HUTTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78634-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-642-6109
Provider Business Practice Location Address Fax Number:
512-642-6194
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  24400 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 24400 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49682253 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1758590 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".