Provider Demographics
NPI:1043861610
Name:NARRA, KIRAN KRISHNA (DMD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:KRISHNA
Last Name:NARRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SAINT STEPHENS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2523
Mailing Address - Country:US
Mailing Address - Phone:512-796-4161
Mailing Address - Fax:
Practice Address - Street 1:150 DEEP WOOD DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4943
Practice Address - Country:US
Practice Address - Phone:512-255-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist