Provider Demographics
NPI:1912095928
Name:ALURU, SUSMITHA (DMD)
Entity Type:Individual
Prefix:
First Name:SUSMITHA
Middle Name:
Last Name:ALURU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W FRONT ST
Mailing Address - Street 2:SUITE#250
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4204
Mailing Address - Country:US
Mailing Address - Phone:512-642-6109
Mailing Address - Fax:512-642-6194
Practice Address - Street 1:409 W FRONT ST
Practice Address - Street 2:SUITE#250
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4204
Practice Address - Country:US
Practice Address - Phone:512-642-6109
Practice Address - Fax:512-642-6194
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244001223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49682253Medicaid
CO1758590OtherUNITED CONCORDIA