Provider Demographics
NPI:1346529807
Name:KUPPERI, VINUTHA
Entity type:Individual
Prefix:
First Name:VINUTHA
Middle Name:
Last Name:KUPPERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 CARRIE ANN LANE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:310-721-5793
Mailing Address - Fax:
Practice Address - Street 1:1309 FIRETHORNE CLUB DR
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-6562
Practice Address - Country:US
Practice Address - Phone:704-499-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice