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General NPI Number Information
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NPI Number | 1063177566
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Entity Type | Organization
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Legal Business Name | DENTIST IN PALM BEACH GARDENS
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 3385 BURNS RD STE 206
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4328
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Country | US
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Telephone | 561-795-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 11903 SOUTHERN BLVD STE 116
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-7644
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Country | US
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Telephone | 561-795-7668
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Fax | 561-795-7884
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUNITHA SIRIVOLU
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Credential | D.M.D
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Telephone | 561-707-2594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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