Provider Demographics
NPI:1225863608
Name:SURABATHULA, VENKATA SRUTHI (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:VENKATA SRUTHI
Middle Name:
Last Name:SURABATHULA
Suffix:
Gender:
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N MAIN ST APT 626
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1135
Mailing Address - Country:US
Mailing Address - Phone:617-817-2284
Mailing Address - Fax:
Practice Address - Street 1:3108 S 31ST ST STE 3108
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1803
Practice Address - Country:US
Practice Address - Phone:254-978-5932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409531223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics