Provider Demographics
NPI:1124354774
Name:POTHAPU, SABITHA (DMD)
Entity type:Individual
Prefix:DR
First Name:SABITHA
Middle Name:
Last Name:POTHAPU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5838
Mailing Address - Country:US
Mailing Address - Phone:214-554-1348
Mailing Address - Fax:
Practice Address - Street 1:14510 JOSEY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4023
Practice Address - Country:US
Practice Address - Phone:972-243-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2015-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice