Organization
OPTIM DENTAL -1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVAS DURSHANAPALLI DDS (PRESIDENT)
(217) 303-5955
Entity
Organization
Contact information
Practice address
3353 S US HIGHWAY 41 UNIT 3369, TERRE HAUTE, IN 47802-3727
(812) 777-8777
Mailing address
3353 S US HIGHWAY 41 UNIT 3369, TERRE HAUTE, IN 47802-3727
(812) 777-8777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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