Provider Demographics
NPI:1750538005
Name:MIYAPURAM, RAMA KRISHNA (DMD)
Entity type:Individual
Prefix:
First Name:RAMA KRISHNA
Middle Name:
Last Name:MIYAPURAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7969
Mailing Address - Country:US
Mailing Address - Phone:203-606-3155
Mailing Address - Fax:817-529-1794
Practice Address - Street 1:5201 E BELKNAP ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-4608
Practice Address - Country:US
Practice Address - Phone:817-529-1791
Practice Address - Fax:817-529-1794
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist