Provider Demographics
NPI:1831598010
Name:MADDIPATI, VIRAJITHA
Entity type:Individual
Prefix:
First Name:VIRAJITHA
Middle Name:
Last Name:MADDIPATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRAJITHA
Other - Middle Name:
Other - Last Name:MADDIPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2323 LONG REACH DR
Mailing Address - Street 2:APT 2205
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4190
Mailing Address - Country:US
Mailing Address - Phone:512-905-8231
Mailing Address - Fax:
Practice Address - Street 1:2323 LONG REACH DR
Practice Address - Street 2:APT 2205
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4190
Practice Address - Country:US
Practice Address - Phone:512-905-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice