Provider Demographics
NPI:1225005259
Name:KALLEPALLI, VAMSI (DMD)
Entity Type:Individual
Prefix:
First Name:VAMSI
Middle Name:
Last Name:KALLEPALLI
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 1:3261 S US HIGHWAY 27 # 441E-1
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-4497
Mailing Address - Country:US
Mailing Address - Phone:352-314-2729
Mailing Address - Fax:352-314-9889
Practice Address - Street 1:3261 S US HIGHWAY 27 # 441E-1
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-4497
Practice Address - Country:US
Practice Address - Phone:352-314-2729
Practice Address - Fax:352-314-9889
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist