Active NPI
Sri Sudha Boppana, DDS, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bingham Farms, MI
National Provider Identifier
1881791408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2901017958
- Practice address
- 30400 Telegraph Rd
Bingham Farms, MI 48025-4537 - Phone
- (248) 901-0718
- NPI assigned
- Sep 17, 2006
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2901017958 | MI | Primary |
Addresses
Primary practice location
30400 Telegraph Rd
Bingham Farms, MI 48025-4537
Mailing address
6845 Carrington Cir E
West Bloomfield, MI 48322-2974
Phone (248) 661-3748
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901017958 | MI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881791408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6845 CARRINGTON CIR E",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483222974",
"telephone_number": "248-661-3748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30400 TELEGRAPH RD",
"city": "BINGHAM FARMS",
"state": "MI",
"postal_code": "480254537",
"telephone_number": "248-901-0718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOPPANA",
"first_name": "SRI SUDHA",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MI",
"license": "2901017958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bingham Farms, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.