Provider Demographics
NPI:1922407865
Name:UPPU, SWATHI
Entity Type:Individual
Prefix:DR
First Name:SWATHI
Middle Name:
Last Name:UPPU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 KENNEDY DR
Mailing Address - Street 2:APT 10
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3402
Mailing Address - Country:US
Mailing Address - Phone:740-407-1345
Mailing Address - Fax:
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:373
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2809
Practice Address - Country:US
Practice Address - Phone:617-887-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist