Provider Demographics
NPI:1427229814
Name:VEMULAPALLI, PRATHIMA SREE PRASANNA (DMD, MMSC)
Entity Type:Individual
Prefix:
First Name:PRATHIMA SREE
Middle Name:PRASANNA
Last Name:VEMULAPALLI
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:PRATHIMA SREE
Other - Middle Name:MENTA
Other - Last Name:PRASANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2727 REVERE ST
Mailing Address - Street 2:#3002
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1328
Mailing Address - Country:US
Mailing Address - Phone:617-283-6428
Mailing Address - Fax:
Practice Address - Street 1:188 LONGWOOD AVE
Practice Address - Street 2:REB 203
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5819
Practice Address - Country:US
Practice Address - Phone:617-283-6428
Practice Address - Fax:617-432-7319
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics