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NPI Code Detail

MEDICARE: PHILOMENA STREET PLLC

MEDICARE: PHILOMENA STREET PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics
21223P0221XPediatric Dentistry
31223P0300XPeriodontics
41223S0112XOral and Maxillofacial Surgery (Dentist)
51223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
6122300000XDentist

General Provider Information

NPI Number : 1821934472
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHILOMENA STREET PLLC
Provider Business Mailing Address
First Line : 1401 PHILOMENA ST
Second Line :
City : AUSTIN
State : TX
Zip : 78723-3574
Country : US
Telephone Number : 737-434-2436
Fax Number :
Provider Business Practice Location Address
First Line : 1401 PHILOMENA ST
Second Line :
City : AUSTIN
State : TX
Zip : 78723-3574
Country : US
Telephone Number : 737-434-2436
Fax Number :
Authorized Official
Title or Position : OWNER
Name : VENKATA KUMAR PASUPULETI
Credential : DDS
Telephone Number : 737-434-2436
Provider Enumeration Date : 04/27/2026
Last Update Date : 04/27/2026

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Directions to “PHILOMENA STREET PLLC ” Practice Location

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