Provider Demographics
NPI:1811921869
Name:ILAPOGU, SUNIL KUMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:KUMAR
Last Name:ILAPOGU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:789 S VICTORIA AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9078
Mailing Address - Country:US
Mailing Address - Phone:805-644-5516
Mailing Address - Fax:805-644-4124
Practice Address - Street 1:789 S VICTORIA AVE STE 206
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9078
Practice Address - Country:US
Practice Address - Phone:805-644-5516
Practice Address - Fax:805-644-4124
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB49762-01OtherHEALTHY FAMILIES
CAB49762-01OtherHEALTHY FAMILIES