Sreenivasulu Panguluri, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

010544 Issued in CT

Practice address

21 Montauk Ave
#102
New London, CT 06320-4906

Phone

(860) 444-9345

Fax

(860) 443-0432

NPI assigned

Jul 5, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309824000000",
    "number": "1770870347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 NORTHAMPTON ST",
            "address_2": "APT#2304",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184014",
            "telephone_number": "419-819-7349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MONTAUK AVE",
            "address_2": "#102",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204906",
            "telephone_number": "860-444-9345",
            "fax_number": "860-443-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANGULURI",
        "first_name": "SREENIVASULU",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-05",
        "last_updated": "2011-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "010544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas David Page
• Izabella Palak, FNP
• Angeline Bossa Pamphile, APRN
• Neil Panchal, D.O
• Christopher J Panebianco, APRN
• Daria Papalia, PH.D.
• Katherine Paquette, LCSW
• Daniel F Parisi, DMD
• Byungchul Park, D.D.S.
• Stefanie Parks

• Dentist in New London, CT
• Providers in New London, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; 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.