| NPI | 1629617154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANTHI KOPURI President 305-788-4415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-01-01 |
| Last Update Date | 2020-01-01 |