Provider Demographics
NPI:1235652769
Name:REGATIPALLI, SWETHA
Entity Type:Individual
Prefix:
First Name:SWETHA
Middle Name:
Last Name:REGATIPALLI
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 1:2725 PAVILION PKWY APT 3211
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9495
Mailing Address - Country:US
Mailing Address - Phone:408-614-6425
Mailing Address - Fax:
Practice Address - Street 1:2313 N CORRAL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9401
Practice Address - Country:US
Practice Address - Phone:408-614-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1015241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice