Provider Demographics
NPI:1962922351
Name:VALLABHANENI, TAPAN TIRUMALA TEJA (DMD)
Entity type:Individual
Prefix:DR
First Name:TAPAN TIRUMALA TEJA
Middle Name:
Last Name:VALLABHANENI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 CENTRE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1859
Mailing Address - Country:US
Mailing Address - Phone:484-636-8001
Mailing Address - Fax:
Practice Address - Street 1:111 N ASH ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-3201
Practice Address - Country:US
Practice Address - Phone:308-334-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34363122300000X
WV42881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist