MEDICARE: ADVANCED PROSTHETIC RESTORATIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	229N00000X	Anaplastologist

General Provider Information

NPI Number	:	1033863238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PROSTHETIC RESTORATIONS

Provider Business Mailing Address
First Line	:	PO BOX 261684
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-1684
Country	:	US
Telephone Number	:	972-696-9497
Fax Number	:	469-409-6142

Provider Business Practice Location Address
First Line	:	2213 MCDERMOTT RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-4613
Country	:	US
Telephone Number	:	972-696-9497
Fax Number	:	469-409-6142

Authorized Official
Title or Position	:	CERTIFIED CLINICAL ANAPLASTOLOGIST
Name	:	SUZANNE NICOLE VERMA
Credential	:	MAMS, CCA
Telephone Number	:	972-696-9497

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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