Provider Demographics
NPI:1821604687
Name:DR. DURSHANAPALLI & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DR. DURSHANAPALLI & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSHANAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-215-4687
Mailing Address - Street 1:414 HAMILTON BLVD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1233
Mailing Address - Country:US
Mailing Address - Phone:217-303-5955
Mailing Address - Fax:
Practice Address - Street 1:2380 HICKSWOOD RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1458
Practice Address - Country:US
Practice Address - Phone:336-899-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty