Provider Demographics
NPI:1962609370
Name:TELLA, SUJATHA NAGA (DDS)
Entity type:Individual
Prefix:
First Name:SUJATHA
Middle Name:NAGA
Last Name:TELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7578 WANDERING WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6929
Mailing Address - Country:US
Mailing Address - Phone:813-804-0533
Mailing Address - Fax:
Practice Address - Street 1:7578 WANDERING WAY STE 210
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6929
Practice Address - Country:US
Practice Address - Phone:813-804-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN265071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice