1427229814 NPI number — PRATHIMA SREE PRASANNA VEMULAPALLI DMD, MMSC

Table of content: PRATHIMA SREE PRASANNA VEMULAPALLI DMD, MMSC (NPI 1427229814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427229814 NPI number — PRATHIMA SREE PRASANNA VEMULAPALLI DMD, MMSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VEMULAPALLI
Provider First Name:
PRATHIMA SREE
Provider Middle Name:
PRASANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD, MMSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PRASANNA
Provider Other First Name:
PRATHIMA SREE
Provider Other Middle Name:
MENTA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427229814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 REVERE ST
Provider Second Line Business Mailing Address:
#3002
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77098-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-283-6428
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
REB 203
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-283-6428
Provider Business Practice Location Address Fax Number:
617-432-7319
Provider Enumeration Date:
03/13/2008

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: 1223P0300X , with the licence number:  21677 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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