Provider Demographics
NPI:1336300763
Name:KATHURIA, PREM K (DDS)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:K
Last Name:KATHURIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 S HWY 17/92
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6516
Mailing Address - Country:US
Mailing Address - Phone:407-339-4700
Mailing Address - Fax:407-339-7736
Practice Address - Street 1:1670 S HWY 17/92
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6516
Practice Address - Country:US
Practice Address - Phone:407-339-4700
Practice Address - Fax:407-339-7736
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0081961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074725400Medicaid