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NPI Code Detail

MEDICARE: AVANTHI KOPURI, DMD, MSD, MHA, PLLC

MEDICARE: AVANTHI KOPURI, DMD, MSD, MHA, 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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryP00000094134FL

General Provider Information

NPI Number : 1689798142
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVANTHI KOPURI, DMD, MSD, MHA, PLLC
Provider Business Mailing Address
First Line : 730 SAND LAKE RD
Second Line : SUITE 124
City : ORLANDO
State : FL
Zip : 32809-7750
Country : US
Telephone Number : 407-850-2355
Fax Number : 407-850-2989
Provider Business Practice Location Address
First Line : 730 SAND LAKE RD
Second Line : SUITE 124
City : ORLANDO
State : FL
Zip : 32809-7750
Country : US
Telephone Number : 407-850-2355
Fax Number : 407-850-2989
Authorized Official
Title or Position : PRESIDENT
Name : DR. AVANTHI KOPURI
Credential : DMD, MSD, MHA
Telephone Number : 305-788-4415
Provider Enumeration Date : 03/19/2007
Last Update Date : 08/28/2020

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