Active NPI
Venkata Mohan K Mutnuri, DDS
- Prosthodontics
- Keller, TX
National Provider Identifier
1932865714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 37586
- Practice address
- 1141 Keller Pkwy Ste B
Keller, TX 76248-1628 - Phone
- (817) 753-0226
- NPI assigned
- Nov 16, 2021
- Last updated
- Nov 16, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 37586 | TX | Primary |
Addresses
Primary practice location
1141 Keller Pkwy Ste B
Keller, TX 76248-1628
Mailing address
880 S Coit Rd Apt 905
Prosper, TX 75078-3011
Phone (201) 970-0273
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37586 | TX | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637020800000",
"number": "1932865714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "880 S COIT RD APT 905",
"city": "PROSPER",
"state": "TX",
"postal_code": "750783011",
"telephone_number": "201-970-0273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 KELLER PKWY STE B",
"city": "KELLER",
"state": "TX",
"postal_code": "762481628",
"telephone_number": "817-753-0226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTNURI",
"first_name": "VENKATA MOHAN",
"middle_name": "K",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-16",
"last_updated": "2021-11-16",
"certification_date": "2021-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TX",
"license": "37586",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keller, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.