Healthcare Provider Details

I. General information

NPI: 1376453548
Provider Name (Legal Business Name): SP FAMILY DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 SW FAIRLAWN RD
TOPEKA KS
66604-3646
US

IV. Provider business mailing address

1813 SW FAIRLAWN RD
TOPEKA KS
66604-3646
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-9443
  • Fax: 785-272-9071
Mailing address:
  • Phone: 785-272-9443
  • Fax: 785-272-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIREESHA PERUMALLA
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 785-272-9443