Provider Demographics
NPI:1730862772
Name:KIRUPALAN, INDUMATHI (DMD)
Entity type:Individual
Prefix:
First Name:INDUMATHI
Middle Name:
Last Name:KIRUPALAN
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 1:7112 ED BLUESTEIN BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2924
Mailing Address - Country:US
Mailing Address - Phone:512-926-7001
Mailing Address - Fax:
Practice Address - Street 1:7112 ED BLUESTEIN BLVD STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2924
Practice Address - Country:US
Practice Address - Phone:512-926-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice