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General NPI Number Information
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NPI Number | 1699647115
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Entity Type | Individual
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Provider Name | ANUSHA BONTHA DMD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 4969 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3657
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Country | US
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Telephone | 863-614-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 600 TECHNOLOGY PARK STE 101
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City | LAKE MARY
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State | FL
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Zip | 32746-7122
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Country | US
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Telephone | 407-543-8514
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN27656
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License Number State | FL
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