Active NPI
Priya Vinothini Colluru
- Prosthodontics
- Fort Worth, TX
National Provider Identifier
1376953471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- S-714
- Practice address
- 3913, Wheeler'S Street
Fort Worth, TX 76111 - Phone
- (682) 747-0111
- Fax
- (504) 941-8170
- NPI assigned
- Apr 29, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | S-714 | LA | Primary |
Addresses
Primary practice location
3913, Wheeler'S Street
Fort Worth, TX 76111
Mailing address
3913, Wheeler'S Street
Fort Worth, TX 76111
Phone (682) 747-0111
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 |
|---|---|---|---|
| S-714 | LA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1376953471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3913, WHEELER'S STREET",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76111",
"telephone_number": "682-747-0111",
"fax_number": "504-941-8170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3913, WHEELER'S STREET",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76111",
"telephone_number": "682-747-0111",
"fax_number": "504-941-8170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLURU",
"first_name": "PRIYA",
"middle_name": "VINOTHINI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-29",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "LA",
"license": "S-714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.