Deeptha Surampudi, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12880 Issued in NC

Practice address

10106 Johnston Rd Ste C
Charlotte, NC 28210-0141

Phone

(704) 557-0011

NPI assigned

Sep 18, 2014

Sex

Female

Sole proprietor

Yes

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crescent Family Dental LLC

  dba Crescent Family Dental

  • Dentist
  • Wheeling, IL
  • NPI 1043749286
  Authorized official Same address or phone
• Deeptha Surampudi DDS PC

  • General Practice Dentistry
  • Charlotte, NC
  • NPI 1659258721
  NPD
• Secure Dental II, LLC

  dba Secure Dental Davenport

  • Dentist
  • Davenport, IA
  • NPI 1902258379
  NPD (past)
• Secure Dental LLC

  • Dentist
  • Peoria, IL
  • NPI 1154607422
  NPD (past)

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1831591106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 LADERA DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281730044",
            "telephone_number": "224-229-9688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10106 JOHNSTON RD STE C",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282100141",
            "telephone_number": "704-557-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURAMPUDI",
        "first_name": "DEEPTHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-18",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "12880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Supportive Housing Communities
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• Supreme Health Systems Inc
• Suprgeon W Webber III DDS Ta
• Siddharth P Sura, MD
• Dharmeshkumar Thakordas Suratwala, MD
• Shashank Suresh, MD
• Visakha Suresh, MD
• Surgassist PLLC
• Kertrina Surgeon

• Dentist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; 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.