1235423112 NPI number — DR. NIVEDITA RUDRAGOUD SEERPI DDS

Table of content: DR. NIVEDITA RUDRAGOUD SEERPI DDS (NPI 1235423112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235423112 NPI number — DR. NIVEDITA RUDRAGOUD SEERPI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEERPI
Provider First Name:
NIVEDITA
Provider Middle Name:
RUDRAGOUD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1235423112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 N HARBOR DR APT 2501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60601-7362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-482-9253
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BRIDENT DENTAL & ORTHODONTICS
Provider Second Line Business Practice Location Address:
3331 SPENCER HIGHWAY
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-668-5544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2011

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: 1223G0001X , with the licence number:  019028805 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 29147 , 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)