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General NPI Number Information
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NPI Number | 1629617154
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Entity Type | Organization
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Legal Business Name | AVANTHI KOPURI, DMD, MSD, MHA, PLLC
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Dates
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Enumeration Date | 01/01/2020
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Last Update Date | 01/01/2020
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Provider Practice Location Address
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Address Line | 2555 W NEW HAVEN AVE
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City | MELBOURNE
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State | FL
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Zip | 32904-3701
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Country | US
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Telephone | 321-728-9999
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Fax | 321-728-5925
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Provider Business Mailing Address
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Address Line | 10322 KENSINGTON SHORE DR
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City | ORLANDO
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State | FL
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Zip | 32827-7307
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Country | US
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Telephone | 305-788-4415
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AVANTHI KOPURI
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Credential | DMD, MSD
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Telephone | 305-788-4415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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