Provider Demographics
NPI:1518606698
Name:WEST UNION FAMILY DENTAL, SURYA PAMULAPATI, BDS, MPH, AEGD, LLC
Entity Type:Organization
Organization Name:WEST UNION FAMILY DENTAL, SURYA PAMULAPATI, BDS, MPH, AEGD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURYA CHAKRAVARTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMULAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MPH, AEGD
Authorized Official - Phone:573-881-8507
Mailing Address - Street 1:818 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1111
Mailing Address - Country:US
Mailing Address - Phone:937-544-3239
Mailing Address - Fax:
Practice Address - Street 1:818 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1111
Practice Address - Country:US
Practice Address - Phone:937-544-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty