Provider Demographics
NPI:1891096533
Name:ADUSUMILLI, PRATHIMA KRISHNA (BDS, DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PRATHIMA
Middle Name:KRISHNA
Last Name:ADUSUMILLI
Suffix:
Gender:F
Credentials:BDS, DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11833 NW 79TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3562
Mailing Address - Country:US
Mailing Address - Phone:561-212-3119
Mailing Address - Fax:
Practice Address - Street 1:11332 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2114
Practice Address - Country:US
Practice Address - Phone:954-418-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics