Healthcare Provider Details

I. General information

NPI: 1235604653
Provider Name (Legal Business Name): HEMA UDUPA B.D.S.,M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 W 144TH ST
OVERLAND PARK KS
66223-2130
US

IV. Provider business mailing address

7617 W 144TH ST
OVERLAND PARK KS
66223-2130
US

V. Phone/Fax

Practice location:
  • Phone: 210-446-9430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number29119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: