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General NPI Number Information
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NPI Number | 1356875868
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Entity Type | Organization
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Legal Business Name | DR. SURENDER TIPPIREDDY DMD LLC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 440 BEECHER RD
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City | GAHANNA
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State | OH
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Zip | 43230-1797
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Country | US
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Telephone | 614-855-5828
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Fax | 614-855-5827
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Provider Business Mailing Address
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Address Line | 440 BEECHER RD
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City | GAHANNA
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State | OH
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Zip | 43230-1797
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Country | US
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Telephone | 614-855-5828
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Fax | 614-855-5827
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | SURENDER TIPPIREDDY
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Credential | DMD
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Telephone | 614-855-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30023515
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License Number State | OH
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