MEDICARE: DR. SMITHA UPPALURI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0023606	TX

General Provider Information

NPI Number	:	1023206786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SMITHA UPPALURI DDS

Provider Business Mailing Address
First Line	:	2924 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6218
Country	:	US
Telephone Number	:	214-352-7668
Fax Number	:	214-352-7670

Provider Business Practice Location Address
First Line	:	2924 W. NORTHWEST HIGHWAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220
Country	:	US
Telephone Number	:	214-352-7668
Fax Number	:	214-352-7670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	08/11/2010

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