Provider Demographics
NPI:1376039909
Name:APEX DENTAL STUDIO, INC
Entity Type:Organization
Organization Name:APEX DENTAL STUDIO, INC
Other - Org Name:APEX DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUVARNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DANTULURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-559-0990
Mailing Address - Street 1:2528 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582
Mailing Address - Country:US
Mailing Address - Phone:574-626-4100
Mailing Address - Fax:574-208-5179
Practice Address - Street 1:2528 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582
Practice Address - Country:US
Practice Address - Phone:574-626-4100
Practice Address - Fax:574-208-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012881A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty