Basic Information
| Provider Information | |||||||||
| NPI: | 1750538005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIYAPURAM | ||||||||
| FirstName: | RAMA KRISHNA | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 AMBERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750197969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036063155 | ||||||||
| FaxNumber: | 8175291794 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 E BELKNAP ST | ||||||||
| Address2: | |||||||||
| City: | HALTOM CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761174608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175291791 | ||||||||
| FaxNumber: | 8175291794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 25217 | TX | Y | Dental Providers | Dentist |
No ID Information.