Healthcare Provider Details

I. General information

NPI: 1508021783
Provider Name (Legal Business Name): SUMESH POTLURI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2008
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 210
SILVER SPRING MD
20901-4454
US

IV. Provider business mailing address

10750 COLUMBIA PIKE STE 210
SILVER SPRING MD
20901-4454
US

V. Phone/Fax

Practice location:
  • Phone: 440-915-1272
  • Fax:
Mailing address:
  • Phone: 440-915-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14941
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.022598
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: