MEDICARE: RUPPAGE DONA SHAMILA MANIK RUPASINGHE

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	1223G0001X	General Practice Dentistry	DN123429	GA

General Provider Information

NPI Number	:	1528802980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUPPAGE DONA SHAMILA MANIK RUPASINGHE

Provider Business Mailing Address
First Line	:	1234 S HAIRSTON RD STE 28
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2766
Country	:	US
Telephone Number	:	347-208-6182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 S HAIRSTON RD STE 28
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2766
Country	:	US
Telephone Number	:	347-208-6182
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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