Provider Demographics
NPI:1831591106
Name:SURAMPUDI, DEEPTHA (DDS)
Entity type:Individual
Prefix:DR
First Name:DEEPTHA
Middle Name:
Last Name:SURAMPUDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BROOK HILL LN
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3142
Mailing Address - Country:US
Mailing Address - Phone:224-275-5215
Mailing Address - Fax:
Practice Address - Street 1:307 S MILWAUKEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5035
Practice Address - Country:US
Practice Address - Phone:847-999-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist