Active NPI
Shruti Mukkamala, DMD
- Dental Anesthesiology
- Sugar Land, TX
National Provider Identifier
1912468588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 39359
- Practice address
- 6006 Cranbrook Canyon CT
Sugar Land, TX 77479-1674 - Phone
- (832) 409-8585
- NPI assigned
- Mar 27, 2019
- 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 |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | 39359 | TX | Primary |
Addresses
Primary practice location
6006 Cranbrook Canyon CT
Sugar Land, TX 77479-1674
Mailing address
6006 Cranbrook Canyon CT
Sugar Land, TX 77479-1674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190815000765 | LA | Order and Referring Only - Dentist | 7416284385 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39359 | TX | MD | Dentist Anesthesiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1912468588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6006 CRANBROOK CANYON CT",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774791674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6006 CRANBROOK CANYON CT",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774791674",
"telephone_number": "832-409-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUKKAMALA",
"first_name": "SHRUTI",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-27",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "TX",
"license": "39359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sugar Land, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.