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General NPI Number Information
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NPI Number | 1285870238
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Entity Type | Individual
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Provider Name | SUSANA GEORGE KULANGARA DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 27510 CASHFORD CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6910
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Country | US
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Telephone | 813-973-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 125 FALLING WATER DR
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City | BRANDON
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State | FL
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Zip | 33511-7859
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Country | US
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Telephone | 813-503-9316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN20023
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License Number State | FL
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