Provider Demographics
NPI:1578325924
Name:KOPPURAVURI DDS PLLC
Entity Type:Organization
Organization Name:KOPPURAVURI DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATASUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPURAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-475-9057
Mailing Address - Street 1:8938 TREMONT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4847 SHOPTON RD STE C-D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6747
Practice Address - Country:US
Practice Address - Phone:704-444-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental