Provider Demographics
NPI:1760277206
Name:KUPPERI AND KOMMINENI DDS PLLC
Entity type:Organization
Organization Name:KUPPERI AND KOMMINENI DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMMINENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-256-8817
Mailing Address - Street 1:1619 S PROVIDENCE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0424
Mailing Address - Country:US
Mailing Address - Phone:704-627-8327
Mailing Address - Fax:
Practice Address - Street 1:1619 S PROVIDENCE RD STE 120
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0424
Practice Address - Country:US
Practice Address - Phone:704-627-8327
Practice Address - Fax:704-370-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center