Provider Demographics
NPI:1255021903
Name:MUSUNURI, SUHRUDWAMSI (DMD)
Entity type:Individual
Prefix:DR
First Name:SUHRUDWAMSI
Middle Name:
Last Name:MUSUNURI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 S HIGHWAY 183 STE 103
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4557
Mailing Address - Country:US
Mailing Address - Phone:512-690-2968
Mailing Address - Fax:
Practice Address - Street 1:1295 S HIGHWAY 183 STE 103
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4557
Practice Address - Country:US
Practice Address - Phone:512-690-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX395971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice