Provider Demographics
NPI:1285227165
Name:GUNARATNE, PRABHA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:PRABHA
Middle Name:
Last Name:GUNARATNE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:PRABHA
Other - Middle Name:
Other - Last Name:GAMLATHARACHCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4809 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1331
Mailing Address - Country:US
Mailing Address - Phone:813-390-9084
Mailing Address - Fax:
Practice Address - Street 1:5348 COUNTY ROAD 581
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8612
Practice Address - Country:US
Practice Address - Phone:813-973-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH16073124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist