MEDICARE: MRS. PRAVEENA ALURI DMD

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	12011908A	IN

General Provider Information

NPI Number	:	1558665612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRAVEENA ALURI DMD

Provider Business Mailing Address
First Line	:	616 RED BLUFF DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9086
Country	:	US
Telephone Number	:	703-907-9957
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 RED BLUFF DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9086
Country	:	US
Telephone Number	:	703-907-9957
Fax Number	:

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

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	07/31/2025

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