# OPTIM DENTAL -1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053852202
- **Authorized official:** SRINIVAS DURSHANAPALLI DDS (PRESIDENT)
- **Authorized official phone:** (217) 303-5955

## Contact information

- **Practice address:** 3353 S US HIGHWAY 41 UNIT 3369, TERRE HAUTE, IN 47802-3727
- **Practice address phone:** (812) 777-8777
- **Mailing address:** 3353 S US HIGHWAY 41 UNIT 3369, TERRE HAUTE, IN 47802-3727
- **Mailing address phone:** (812) 777-8777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/20/2017
- **Last updated:** 03/20/2017