Provider Demographics
NPI:1083844716
Name:PACHIPULUSU, AJAY
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:PACHIPULUSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 LBJ FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7770
Mailing Address - Country:US
Mailing Address - Phone:972-444-8888
Mailing Address - Fax:972-243-6059
Practice Address - Street 1:3010 LBJ FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7770
Practice Address - Country:US
Practice Address - Phone:972-444-8888
Practice Address - Fax:972-243-6059
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice