Shouvik Ponnusamy, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

38050 Issued in TX

Practice address

4010 Sandy Brook Dr Ste 204
Round Rock, TX 78665-1518

Phone

(512) 456-3161

NPI assigned

Apr 29, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Niva Dental Specialists PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Leander, TX
  • NPI 1194436634
  NPD Authorized official
• Affordable Dentures & Implants - Texas, PLLC

  • General Practice Dentistry
  • Round Rock, TX
  • NPI 1528632932

  Single Specialty

  NPD

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1457706202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 RIMSTONE DR",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786137692",
            "telephone_number": "630-267-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 SANDY BROOK DR STE 204",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651518",
            "telephone_number": "512-456-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNUSAMY",
        "first_name": "SHOUVIK",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-29",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "38050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Elizabeth Pokluda, ATC
• Polished Smiles of Round Rock PLLC
• Nathaniel M. Polnaszek, MD
• Amalee Denise Ponder, RBT
• Rosabelle Pong, PA-C
• Lena A Poole, MD
• Sonia Popatia, M.D
• Carmen Aurora Popkoff
• Jan Manuel Andrade Poquiz, PHARMD
• Vijayrama Reddy Poreddy, MD

• Oral and Maxillofacial Surgery (Dentist) in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.