Provider Demographics
NPI:1114207115
Name:KUMARSWAMY, AKSHAY ASWATHA (BDS , MS)
Entity Type:Individual
Prefix:
First Name:AKSHAY
Middle Name:ASWATHA
Last Name:KUMARSWAMY
Suffix:
Gender:M
Credentials:BDS , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S UNIVERSITY DR RM 7332
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-7357
Mailing Address - Fax:954-262-1782
Practice Address - Street 1:3200 S UNIVERSITY DR RM 7332
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-7357
Practice Address - Fax:954-262-1782
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP5521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics