Provider Demographics
NPI:1356110852
Name:VIVA SMILES WELLS BRANCH PLLC
Entity type:Organization
Organization Name:VIVA SMILES WELLS BRANCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DURSHANAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-215-4687
Mailing Address - Street 1:1420 W WELLS BRANCH PKWY STE 490
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3170
Mailing Address - Country:US
Mailing Address - Phone:512-838-3888
Mailing Address - Fax:512-953-2888
Practice Address - Street 1:1420 W WELLS BRANCH PKWY STE 490
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3170
Practice Address - Country:US
Practice Address - Phone:512-838-3888
Practice Address - Fax:512-953-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty