Provider Demographics
NPI:1235519208
Name:ADUSUMILLI, VENKATA RAMA KRISHNA RAO (DDS)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:RAMA KRISHNA RAO
Last Name:ADUSUMILLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 FM 1283 STE L
Mailing Address - Street 2:
Mailing Address - City:LAKEHILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6273
Mailing Address - Country:US
Mailing Address - Phone:830-612-2626
Mailing Address - Fax:
Practice Address - Street 1:8500 FM 1283 STE L
Practice Address - Street 2:
Practice Address - City:LAKEHILLS
Practice Address - State:TX
Practice Address - Zip Code:78063-6273
Practice Address - Country:US
Practice Address - Phone:830-612-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040693122300000X
TX30930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30930OtherTEXAS DENTAL LICENSE
PAPA040693OtherPA STATE DENTAL LICENSE