Provider Demographics
NPI:1083196729
Name:THATAVARTHY FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:THATAVARTHY FAMILY DENTAL PLLC
Other - Org Name:ORANGE GROVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIVIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VULUGUNDAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-294-8153
Mailing Address - Street 1:9319 MANGROVE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3356
Mailing Address - Country:US
Mailing Address - Phone:571-294-8153
Mailing Address - Fax:
Practice Address - Street 1:4122 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6122
Practice Address - Country:US
Practice Address - Phone:727-645-6943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty