Healthcare Provider Details

I. General information

NPI: 1891312211
Provider Name (Legal Business Name): SAUMYA VULLAGANTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 S SHERIDAN RD
TULSA OK
74129-1001
US

IV. Provider business mailing address

8300 E 123RD ST S # C-311
BIXBY OK
74008-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-948-6965
  • Fax:
Mailing address:
  • Phone: 609-227-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7330
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: