| NPI | 1316402878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRATHIMA ADUSUMILLI Owner 954-642-1013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2019-02-08 |