Provider Demographics
NPI:1508021783
Name:POTLURI, SUMESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUMESH
Middle Name:
Last Name:POTLURI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 ANDOVER CIR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4250
Mailing Address - Country:US
Mailing Address - Phone:440-915-1272
Mailing Address - Fax:
Practice Address - Street 1:19551 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1409
Practice Address - Country:US
Practice Address - Phone:216-692-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist