Provider Demographics
NPI:1063525731
Name:ATLURI, SUNEETHA (DMD)
Entity type:Individual
Prefix:
First Name:SUNEETHA
Middle Name:
Last Name:ATLURI
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 1:16503 DIAMOND HEAD DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3107
Mailing Address - Country:US
Mailing Address - Phone:954-217-3777
Mailing Address - Fax:954-248-2484
Practice Address - Street 1:700 W HILLSBORO BLVD STE 1-109
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1613
Practice Address - Country:US
Practice Address - Phone:954-698-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075338600Medicaid