Provider Demographics
NPI:1316354467
Name:KUMAR, SOWMYA RAO (DMD)
Entity type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:RAO
Last Name:KUMAR
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 1:2070 US HIGHWAY 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3745
Mailing Address - Country:US
Mailing Address - Phone:321-631-4334
Mailing Address - Fax:
Practice Address - Street 1:2070 US HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3745
Practice Address - Country:US
Practice Address - Phone:321-631-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN206311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice