Healthcare Provider Details

I. General information

NPI: 1548150725
Provider Name (Legal Business Name): USHA SRI BOLLINENI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SANTA FE DR
OVERLAND PARK KS
66212-3654
US

IV. Provider business mailing address

8700 SANTA FE DR
OVERLAND PARK KS
66212-3654
US

V. Phone/Fax

Practice location:
  • Phone: 913-416-4660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62425
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: