Provider Demographics
NPI:1376983718
Name:KOLAPPA, SHRADDHA PATEL (DDS)
Entity Type:Individual
Prefix:
First Name:SHRADDHA
Middle Name:PATEL
Last Name:KOLAPPA
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 1:1000 CRESCENT GREEN DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-4377
Mailing Address - Country:US
Mailing Address - Phone:919-851-0011
Mailing Address - Fax:
Practice Address - Street 1:1000 CRESCENT GREEN DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-3009
Practice Address - Country:US
Practice Address - Phone:919-851-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95271223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program