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General NPI Number Information
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NPI Number | 1265975312
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Entity Type | Individual
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Provider Name | SIDDARDHA CHANDRUPATLA DDS MMSC
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Gender | Male
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 15132 OLD GALVESTON RD
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City | WEBSTER
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State | TX
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Zip | 77598-1821
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Country | US
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Telephone | 281-990-7462
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Fax |
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Provider Business Mailing Address
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Address Line | 15132 OLD GALVESTON RD
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City | WEBSTER
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State | TX
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Zip | 77598-1821
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Country | US
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Telephone | 281-990-7462
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 33470
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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 | 33470
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DL12935
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 33470
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License Number State | TX
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