Active NPI
Rishank Reddy Korupolu, D.D.S.
- Dentist
- Longview, TX
National Provider Identifier
1295177012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 29361
- Practice address
- 3052 N Eastman Rd
Longview, TX 75605-5093 - Phone
- (903) 663-6900
- NPI assigned
- Jul 22, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 29361 | TX | Primary |
Addresses
Primary practice location
3052 N Eastman Rd
Longview, TX 75605-5093
Mailing address
PO Box 15781
Brooksville, FL 34604-0124
Phone (352) 346-7989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29361 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ridge Manor Family Clinic Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Physician
- Brooksville, FL
- NPI 1730577115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374451200000",
"number": "1295177012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15781",
"city": "BROOKSVILLE",
"state": "FL",
"postal_code": "346040124",
"telephone_number": "352-346-7989",
"fax_number": "352-799-3214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3052 N EASTMAN RD",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055093",
"telephone_number": "903-663-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORUPOLU",
"first_name": "RISHANK",
"middle_name": "REDDY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-22",
"last_updated": "2013-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "29361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.