Provider Demographics
NPI:1578784732
Name:BOPPANA, SUNEETHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUNEETHA
Middle Name:
Last Name:BOPPANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUNEETHA
Other - Middle Name:
Other - Last Name:PARVATHANENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:400 N ZANG BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4447
Mailing Address - Country:US
Mailing Address - Phone:214-390-9960
Mailing Address - Fax:214-390-9961
Practice Address - Street 1:400 N ZANG BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4447
Practice Address - Country:US
Practice Address - Phone:214-390-9960
Practice Address - Fax:214-390-9961
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry