Provider Demographics
NPI:1518417419
Name:YERRAPRAGADA, SUNETHRA KEMPARAJURS (DMD)
Entity Type:Individual
Prefix:
First Name:SUNETHRA
Middle Name:KEMPARAJURS
Last Name:YERRAPRAGADA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 MCINTOSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2480
Mailing Address - Country:US
Mailing Address - Phone:502-693-3378
Mailing Address - Fax:
Practice Address - Street 1:2200 E 104TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4402
Practice Address - Country:US
Practice Address - Phone:303-452-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002050751223G0001X
WADE60665342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist