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General NPI Number Information
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NPI Number | 1225863608
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Entity Type | Individual
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Provider Name | VENKATA SRUTHI SURABATHULA BDS, MS
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Gender | Female
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 3108 S 31ST ST STE 3108
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City | TEMPLE
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State | TX
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Zip | 76502-1803
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Country | US
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Telephone | 254-978-5932
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 N MAIN ST APT 626
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City | BELTON
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State | TX
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Zip | 76513-1135
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Country | US
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Telephone | 617-817-2284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 40953
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40953
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License Number State | TX
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