Provider Demographics
NPI:1225704737
Name:VUPPULURI, DEEPTI REDDY
Entity Type:Individual
Prefix:
First Name:DEEPTI REDDY
Middle Name:
Last Name:VUPPULURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S KENNEY FORT BLVD APT 516
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2029
Mailing Address - Country:US
Mailing Address - Phone:678-428-9123
Mailing Address - Fax:
Practice Address - Street 1:301 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2653
Practice Address - Country:US
Practice Address - Phone:678-428-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice