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General NPI Number Information
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NPI Number | 1790148294
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Entity Type | Organization
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Legal Business Name | DENTAL BRACES GURU PLLC
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 11330 WILES RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-2113
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Country | US
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Telephone | 954-418-2354
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Fax | 954-369-1440
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Provider Business Mailing Address
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Address Line | 11332 WILES RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-2114
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Country | US
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Telephone | 954-418-2354
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Fax | 954-369-1440
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRATHIMA KRISHNA ADUSUMILLI
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Credential | DMD, MS
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Telephone | 561-212-3119
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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 | DN 18968
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License Number State | FL
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