MEDICARE: DR. ANURADHA AMARA DDS

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	122300000X	Dentist	27204	TX

General Provider Information

NPI Number	:	1538457916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANURADHA AMARA DDS

Provider Business Mailing Address
First Line	:	1827 E PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4638
Country	:	US
Telephone Number	:	817-275-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1827 E PARK ROW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4638
Country	:	US
Telephone Number	:	817-275-4322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	11/21/2011

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