Individual provider Active NPI

Sirisha Nemallapudi, D M D.

  • General Practice Dentistry
  • Troy, MI
National Provider Identifier
1346392693
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901017598 Issued in MI
Practice address
4000 Livernois Rd Ste 100
Troy, MI 48098-4712
Phone
(248) 813-7700
Fax
(248) 813-8780
NPI assigned
Jan 17, 2007
Last updated
May 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901017598 MI
General Practice Dentistry 1223G0001X 2901017598 MI Primary

Addresses

Primary practice location

4000 Livernois Rd Ste 100
Troy, MI 48098-4712

Mailing address

4000 Livernois Rd Ste 100
Troy, MI 48098-4712
Phone (248) 813-7700

Other practice location 1

4000 Livernois Rd
Troy, MI 48098-4712
Phone (248) 813-7700

Other practice location 2

36650 Grand River Ave Ste 100
Farmington Hills, MI 48335-2919
Phone (248) 313-8000

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

LicenseStateTypeSpecialty
2901017598MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Smile Centers PC General Practice CurrentSince Dec 29, 2024 Accepting new patients
Edental PLLC Current Accepting new patients

Locations

4000 Livernois Rd
Ste 100
Troy, MI 48098
Phone (248) 813-7700

5942 Livernois Rd
Troy, MI 48098
Phone (248) 250-9269

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1346392693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LIVERNOIS RD STE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480984712",
            "telephone_number": "248-813-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 LIVERNOIS RD STE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480984712",
            "telephone_number": "248-813-7700",
            "fax_number": "248-813-8780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4000 Livernois Rd",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480984712",
            "country_code": "US",
            "telephone_number": "248-813-7700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "36650 Grand River Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483352919",
            "country_code": "US",
            "telephone_number": "248-313-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEMALLAPUDI",
        "first_name": "SIRISHA",
        "name_prefix": "Dr.",
        "credential": "D M D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901017598",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901017598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.