Healthcare Provider Details

I. General information

NPI: 1306688742
Provider Name (Legal Business Name): SPOORTHI ALAPATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MILLERSVILLE PIKE
LANCASTER PA
17603-6656
US

IV. Provider business mailing address

212 PATRIOTS PATH
MALVERN PA
19355-0269
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-4300
  • Fax:
Mailing address:
  • Phone: 314-365-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS044795
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: