Provider Demographics
NPI:1730600610
Name:SUMESH POTLURI DMD MSD PC
Entity type:Organization
Organization Name:SUMESH POTLURI DMD MSD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:POTLURI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:301-754-0500
Mailing Address - Street 1:10750 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901
Mailing Address - Country:US
Mailing Address - Phone:301-754-0500
Mailing Address - Fax:301-754-1220
Practice Address - Street 1:10750 COLUMBIA PIKE
Practice Address - Street 2:SUITE 210
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-754-0500
Practice Address - Fax:301-754-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty