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General NPI Number Information
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NPI Number | 1245953249
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Entity Type | Organization
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Legal Business Name | IVYARUPA SUNKARA DDS INC
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 2321 NORTHGATE BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95833-2504
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Country | US
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Telephone | 510-219-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 6324 LOOKOUT PASS WAY
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City | ROCKLIN
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State | CA
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Zip | 95765-4547
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Country | US
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Telephone | 510-219-4250
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DIVYARUPA SUNKARA
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Credential | DDS
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Telephone | 510-219-4250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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