Provider Demographics
NPI:1306684535
Name:KONDAPALLI, TULASI PRIYA (DMD)
Entity type:Individual
Prefix:
First Name:TULASI PRIYA
Middle Name:
Last Name:KONDAPALLI
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 1:1439 N HIGHWAY 77 # 101
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5120
Mailing Address - Country:US
Mailing Address - Phone:469-701-3460
Mailing Address - Fax:
Practice Address - Street 1:1439 N HIGHWAY 77 # 101
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5120
Practice Address - Country:US
Practice Address - Phone:469-701-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX408251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice