Provider Demographics
NPI:1619083607
Name:DOPPALAPUDI, VIVEK (DDS MS DMSC)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:DOPPALAPUDI
Suffix:
Gender:M
Credentials:DDS MS DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ELDEN ST
Mailing Address - Street 2:STE 19
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4868
Mailing Address - Country:US
Mailing Address - Phone:703-464-0900
Mailing Address - Fax:703-481-1742
Practice Address - Street 1:102 ELDEN ST
Practice Address - Street 2:STE 19
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4868
Practice Address - Country:US
Practice Address - Phone:703-464-0900
Practice Address - Fax:703-481-1742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC58551223P0300X
VA04010089581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics