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General NPI Number Information
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NPI Number | 1407625254
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Entity Type | Individual
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Provider Name | VENKATA NAGA SRIDEVI SURAMPUDI DDS
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 606 SUMNER AVE
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City | SPRINGFIELD
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State | MA
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Zip | 01108-2459
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Country | US
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Telephone | 417-619-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MATTHEW DR
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City | SUFFIELD
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State | CT
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Zip | 06078-1385
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Country | US
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Telephone | 417-763-0707
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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 | DN1860054
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License Number State | MA
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