Venkatasuman Koppuravuri, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10067 Issued in SC

Practice address

3010 LBJ Fwy Ste 200
Dallas, TX 75234-2723

Phone

(972) 444-8888

Fax

(972) 243-6059

NPI assigned

Jul 7, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Koppuravuri DDS PLLC

  • Dental Clinic/Center
  • Charlotte, NC
  • NPI 1578325924
  NPD Authorized official
• JDC Healthcare, PLLC

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1003017096
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1245469618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2298 CHERRY ROAD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "29732",
            "telephone_number": "038-980-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 LBJ FWY STE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752342723",
            "telephone_number": "972-444-8888",
            "fax_number": "972-243-6059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPURAVURI",
        "first_name": "VENKATASUMAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-07",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24699",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.023362",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "10623",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Risha Kopel, M.D.
• Jeffrey M. Kopita, M.D.
• Ellyn Baker Kopp, APRN, CPNP-PC
• Jamie Kay Kopp, PTA
• Rachel Wagner Koppa, PHD, LPC, LMFT
• Raven Kopru
• Joe Ji Kor, CRNA
• Gautej Koradia, PHARM D
• Kadriye Meltem Koral, MD
• Korgun Koral, MD

• General Practice Dentistry in Dallas, TX
• Providers in Dallas, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.