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General NPI Number Information
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NPI Number | 1891096533
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Entity Type | Individual
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Provider Name | PRATHIMA KRISHNA ADUSUMILLI B.D.S, D.M.D, M.S
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Gender | Female
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 06/09/2014
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Provider Practice Location 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 |
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Provider Business Mailing Address
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Address Line | 11833 NW 79TH CT
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3562
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Country | US
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Telephone | 561-212-3119
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN18968
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License Number State | FL
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