Provider Demographics
NPI:1528802980
Name:RUPASINGHE, RUPPAGE DONA SHAMILA MANIK
Entity type:Individual
Prefix:
First Name:RUPPAGE
Middle Name:DONA SHAMILA MANIK
Last Name:RUPASINGHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAMILA
Other - Middle Name:M
Other - Last Name:RUPASINGHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1234 S HAIRSTON RD STE 28
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2766
Mailing Address - Country:US
Mailing Address - Phone:347-208-6182
Mailing Address - Fax:
Practice Address - Street 1:1234 S HAIRSTON RD STE 28
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2766
Practice Address - Country:US
Practice Address - Phone:347-208-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1234291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice