Provider Demographics
NPI:1669853503
Name:BUCHUPALLY, DURGA (DDS)
Entity Type:Individual
Prefix:
First Name:DURGA
Middle Name:
Last Name:BUCHUPALLY
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 1:940 SARATOGA WAY
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2212 CENTRAL DR STE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5835
Practice Address - Country:US
Practice Address - Phone:817-464-8655
Practice Address - Fax:817-720-9902
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist