Provider Demographics
NPI:1811321003
Name:NAMBURI, SUNEEL KUMAR (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNEEL
Middle Name:KUMAR
Last Name:NAMBURI
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 1:85 W HWY 22
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87052
Mailing Address - Country:US
Mailing Address - Phone:630-730-9676
Mailing Address - Fax:
Practice Address - Street 1:800 JUAN TABO BLVD NE
Practice Address - Street 2:STE Q
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1444
Practice Address - Country:US
Practice Address - Phone:630-730-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32284756Medicaid
TX337266602Medicaid