Provider Demographics
NPI:1235423112
Name:SEERPI, NIVEDITA RUDRAGOUD (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:RUDRAGOUD
Last Name:SEERPI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N HARBOR DR APT 2501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7362
Mailing Address - Country:US
Mailing Address - Phone:919-482-9253
Mailing Address - Fax:
Practice Address - Street 1:BRIDENT DENTAL & ORTHODONTICS
Practice Address - Street 2:3331 SPENCER HIGHWAY
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504
Practice Address - Country:US
Practice Address - Phone:281-668-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190288051223G0001X
TX291471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice