Healthcare Provider Details

I. General information

NPI: 1891006060
Provider Name (Legal Business Name): ANITHA POTLURI DMD, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE STREET SUITE 3189
PITTSBURGH PA
15261
US

IV. Provider business mailing address

3501 TERRACE STREET SUITE 3189
PITTSBURGH PA
15261
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-9100
  • Fax: 412-383-7862
Mailing address:
  • Phone: 412-648-9100
  • Fax: 412-383-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDS038285
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: