Provider Demographics
NPI:1558665612
Name:ALURI, PRAVEENA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:PRAVEENA
Middle Name:
Last Name:ALURI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 RED BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9086
Mailing Address - Country:US
Mailing Address - Phone:703-907-9957
Mailing Address - Fax:
Practice Address - Street 1:616 RED BLUFF DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9086
Practice Address - Country:US
Practice Address - Phone:703-907-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011908B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist