Provider Demographics
NPI:1629381710
Name:KOLLI, USHA KIRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:USHA KIRAN
Middle Name:
Last Name:KOLLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BUCKINGHAM RD
Mailing Address - Street 2:#327
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5701
Mailing Address - Country:US
Mailing Address - Phone:972-207-4050
Mailing Address - Fax:
Practice Address - Street 1:2145 N JOSEY LN
Practice Address - Street 2:220
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2992
Practice Address - Country:US
Practice Address - Phone:972-820-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00257411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice