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General NPI Number Information
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NPI Number | 1831591106
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Entity Type | Individual
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Provider Name | DEEPTHA SURAMPUDI DDS
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Gender | Female
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 10106 JOHNSTON RD STE C
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City | CHARLOTTE
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State | NC
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Zip | 28210-0141
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Country | US
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Telephone | 704-557-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 LADERA DR
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City | WAXHAW
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State | NC
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Zip | 28173-0044
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Country | US
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Telephone | 224-229-9688
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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 | 12880
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License Number State | NC
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