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730 Sand Lake Rd Suite 124 Orlando FL 32809-7750 | |
| (407) 850-2355 | |
| (407) 850-2989 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 730 Sand Lake Rd, Orlando, Florida |
| Authorized Official Name and Position | Avanthi Kopuri (PRESIDENT) |
| Authorized Official Contact | 3057884415 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
730 Sand Lake Rd Suite 124 Orlando FL 32809-7750 Ph: (407) 850-2355 | 730 Sand Lake Rd Suite 124 Orlando FL 32809-7750 Ph: (407) 850-2355 |
| NPI Number | 1689798142 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 08/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689798142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | P00000094134 (Florida) | Primary |
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