MEDICARE: THATAVARTHY FAMILY DENTAL PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083196729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THATAVARTHY FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	9319 MANGROVE CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3356
Country	:	US
Telephone Number	:	571-294-8153
Fax Number	:

Provider Business Practice Location Address
First Line	:	4122 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6122
Country	:	US
Telephone Number	:	727-645-6943
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. SRIVIDYA VULUGUNDAM
Credential	:	DDS
Telephone Number	:	571-294-8153

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/26/2024

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