Provider Demographics
NPI:1679149124
Name:MUPPALLA, KARTHIK
Entity Type:Individual
Prefix:
First Name:KARTHIK
Middle Name:
Last Name:MUPPALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 SUNWAY TER
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5848
Mailing Address - Country:US
Mailing Address - Phone:410-782-9450
Mailing Address - Fax:
Practice Address - Street 1:7350 VAN DUSEN RD STE 440
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5265
Practice Address - Country:US
Practice Address - Phone:941-405-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist