Provider Demographics
NPI:1801409586
Name:THIRUMOORTHY, SOUMYA (MDS)
Entity Type:Individual
Prefix:
First Name:SOUMYA
Middle Name:
Last Name:THIRUMOORTHY
Suffix:
Gender:F
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-3918
Mailing Address - Country:US
Mailing Address - Phone:361-853-1900
Mailing Address - Fax:361-853-1904
Practice Address - Street 1:5733 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-3918
Practice Address - Country:US
Practice Address - Phone:361-853-1900
Practice Address - Fax:361-853-1904
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics