MEDICARE: DR. PRATHIMA KRISHNA ADUSUMILLI B.D.S, D.M.D, M.S

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN18968	FL

General Provider Information

NPI Number	:	1891096533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRATHIMA KRISHNA ADUSUMILLI B.D.S, D.M.D, M.S

Provider Business Mailing Address
First Line	:	11833 NW 79TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3562
Country	:	US
Telephone Number	:	561-212-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	11332 WILES RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2114
Country	:	US
Telephone Number	:	954-418-2354
Fax Number	:

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

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	06/09/2014

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