=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710418496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRASHANT RUPAPARA & ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2017
-----------------------------------------------------
Last Update Date | 03/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1424A FERN CREEK DR
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28625-9376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-431-1854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1424A FERN CREEK DR
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28625-9376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST-OWNER
-----------------------------------------------------
Name | PRASHANT RUPAPARA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 404-431-1854
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 10441
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------