Provider Demographics
NPI:1750909263
Name:SV DENTAL
Entity type:Organization
Organization Name:SV DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAPAN TIRUMALA
Authorized Official - Middle Name:TEJA
Authorized Official - Last Name:VALLABHANENI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:830-334-3333
Mailing Address - Street 1:111 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-3201
Mailing Address - Country:US
Mailing Address - Phone:830-334-3333
Mailing Address - Fax:830-334-3337
Practice Address - Street 1:111 N ASH ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-3201
Practice Address - Country:US
Practice Address - Phone:830-334-3333
Practice Address - Fax:830-334-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962922351OtherINDIVIDUAL NPI