Provider Demographics
NPI:1376856971
Name:MUPPURU, THULASISWARNALATHA (DDS)
Entity Type:Individual
Prefix:
First Name:THULASISWARNALATHA
Middle Name:
Last Name:MUPPURU
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 1:2565 SANDOWN CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1589
Mailing Address - Country:US
Mailing Address - Phone:609-529-8935
Mailing Address - Fax:
Practice Address - Street 1:3590 BRASELTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1120
Practice Address - Country:US
Practice Address - Phone:678-714-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103181223G0001X
GADN0160171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice